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Blood Glucose Monitoring

Blood glucose monitoring reveals individual patterns of blood glucose changes, and helps in the planning of meals, activities, and at what time of day to take medications. Also, testing allows for quick response to high blood sugar (hyperglycemia) or low blood sugar (hypoglycemia). This might include diet adjustments, exercise, and insulin dose. Measuring HbA1c is the primary method of assessing long-term glycemic control, and for most patients checking HbA1c every three months or so is enough. However, the HbA1c cannot measure glucose level variability or detect hypoglycemia so checking blood glucose is necessary, and self-monitoring of blood glucose should be done before meals, at bedtime, if there are signs and symptoms of hypoglycemia, before exercising, and in some other situations. This may require checking blood glucose by fingerstick 6-10 times a day, and the need for such frequent blood glucose checks can be reduced by use of a continuous glucose monitoring device (CGM). Continuous glucose monitoring devices can provide better glycemic control (decreased HbA1c) than self-monitoring, their use can reduce the incidence of hypoglycemic events, and these advantages are especially strong for patients who have frequent episodes of hypoglycemia and/or hypoglycemic unawareness. The use of a CGM, however, does not mean that patients never need to check blood glucose.

Many benefits:
Can reveal individual patterns of blood glucose changes
Helps to plan meals & activities
Helps determine optimal time to take medications
Allows for quick response to blood glucose being out of range
 
CGMs may be used to monitor blood glucose

Summary

Take look at the main points we covered today.

We discussed the primary goal of medication therapies for types 1 and 2 diabetes as the maintenance of an acceptable level of glycemic control, which may vary according to the patient risks and conditions.

Primary goals in treatment with diabetes medications

   Maintenance of glycemic control: glucose and A1c levels

In addition, we listed and briefly discussed a number of medications that may fall into several categories, including exogenous replacement of insulin, increasing production and availability of endogenous insulin, improvement of insulin sensitivity, reduction of liver glucose release, and medications that slow gastric motility or other mechanisms to reduce absorption rate of dietary carbohydrates.

Categories of medications used in treatment of diabetes

   Insulin replacement

   Medications that increase insulin production and secretion

   Medications that improve insulin sensitivity

   Medications that reduce liver glucose production

   Medications that slow carbohydrate absorption

 

And we also briefly discussed the barriers to both insulin and oral medication uses, including the patient-centric and non-patient-centric factors associated with non-adherence.

Barriers to insulin and oral medication use

 

Thanks for your participation and attention today! These issues are important for health-related professionals to understand with our large and probably growing population of patients with diabetes.

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