TPN

Blood Glucose Monitoring

Type 2 diabetes: insulin-using (basal and bolus) –Fasting –Pre-meals, pre-snacks, bedtime –Prior to sports/exercise or driving –One hour post-meals (each meal once/week) Type 2 diabetes: insulin-using (basal only) –Twice daily, prior to meals –Rotating test times for fasting and pre-meal –Post-meal once weekly for each mealtime
Patients with type 2 diabetes who use insulin will also need to monitor blood glucose closely to match insulin dose and timing with meals. For patients using both long and short-acting insulin, the schedule will include more testing around mealtimes. For those using long-acting insulin only, there may be intermittent testing to assure blood glucose control at fasting and prior to meals. Testing on a rotating basis will help to identify any need for changes in meal or insulin routines.
Type 2 diabetes: non-insulin-using –Once daily –Rotate test times Continuous Glucose Monitoring (GCM)
For non-insulin using type 2 diabetes, the patient may not need to monitor blood sugars quite as closely once their routine for diet, exercise, and medications are set up and comfortable. Glucose monitoring can be rotated and conducted when there is a change in diet and exercise routine. Continuous glucose monitoring, or GCM, systems work using a sensor under the skin to test glucose levels. These devices are approved by the FDA and are available by prescription. Users still need to confirm glucose levels with a glucose meter before making changes in their treatments.
Summary Diabetes is a common and costly health care issue •Treatment goals include management of blood glucose, blood pressure and blood lipids in order to prevent serious complications. •Treatment strategies include dietary modulation, physical activity, emotional well-being and medications (as needed) •Glucose monitoring is essential for optimal blood sugar management and prevention of acute complications.
So as we have seen, diabetes prevalence has increased, now affecting about 8.3% of the population, and though it is the 7th leading cause of death, that number is likely under-reported. Diabetes was associated with approximately $218 billion in costs in 2007. Both prevalence rates and costs continue to increase. The primary treatment goal is blood glucose control. There is evidence that controlling blood glucose can pay off in terms of improved outcomes. Treatment strategies include dietary modification and physical activity, which would be appropriate for both people with or without diabetes. Medications may be required to augment diet and exercise therapy. In addition, treatment strategies will include the prevention and treatment of secondary complications, such as hypertension and cardiovascular disease. Monitoring is geared to both the management of blood glucose and prevention and treatment of the complications of diabetes. Both care giver and patient education is key in effectively managing diabetes.

Graphic credit: National Diabetes Information Clearinghouse (NDIC). Available at: http://diabetes.niddk.nih.gov/dm/pubs/glucosemonitor/index.htm.

Information on GCM: www.fda.gov/diabetes/glucose.html.