Blood Sugar Check

Blood sugar can be checked by patients at home. This is called SMBG (self-monitoring blood glucose) or in the laboratory. Small portable hand held battery operated devices are in common use. The accuracy has about 10% variability as compared to laboratory testing.

Indications :

All cases of Type I Diabetes mellitus should frequently check blood sugars. This should be done multiple times daily in most cases as fluctuations are more common in Type I DM

  • by those on multiple insulin injections daily,
  • while adjusting insulin doses,
  • when hypoglycemia is suspected,
  • before exercise /games etc
  • before driving.
  • During travel

It is required less frequently in Type II Diabetes. It is checked for patients on insulin and those having hypoglycemic episodes. Once a week check may be enough for most patients. Those who are on a tight control of sugars require more frequent checks.

It is also recommended during treatment of hypoglycemia to ensure that blood levels of glucose have improved and remain improved.

Time of Testing :

For type II cases and those suspected to have hypoglycemia often, morning and before dinner levels are useful. However, treatment should not be delayed in serious hypoglycemia suspicions as delay in correcting glucose levels may cause permanent injury to some organs especially nervous system.

Methods :

Venous or capillary blood is used for measurement of blood sugar. It can be measured in plasma or serum. Capillary and plasma levels are 10% lower and higher compared to venous and serum levels due to glucose utilization by tissues and RBCs.

Glucometers use strips impregnated with glucose oxidase. Most show plasma glucose rather than whole blood levels.

Calibration is required before using a fresh set of strips.

Best results are obtained if a lancet is used for puncture of the skin. Blood should come out easily rather than being squeezed from the fingertip. Sides of terminal digits should be used as punctures in front areas would be painful when hands are used. Hands should be washed and dried before a sample is taken.

Higher values may not be measured precisely and are often shown as High levels.

Test strips should be fresh and manufacturers guidelines should be adhered to.

Units of Measurement :

Old methods report sugar level in mg/deciliter while the newer methods are in mmol/liter. To convert from mg/dl to mmol /l the former values are divided by 18.

HbA1C or glycated Hb measures level over previous 12 weeks or so. The test, however, should be done in a fasting stage and is a good guide for overall diabetic control.

Treatment of Diabetes in Type II Diabetes Mellitus

Treatment of Diabetes in Type II Diabetes Mellitus

Treatment of diabetes starts with educating patient about this disease. He is also educated about symptoms related to low and high sugar levels so that he can recognise these. He is encouraged to carry a diabetes card with his medication, and the name of his doctor written on it. He is also encouraged to carry with him sugar candies etc near him to treat hypoglycemia. Home blood glucose monitoring can be taught to nearly all patients.

The various risk factors are noted and the complications if any are studied. The goal of treatment is to reduce the sugar to near normal levels to ward off complications of diabetes and reduce risk to life, vital organs while permitting a good quality of life.

Non-pharmacologic measures

To reduce risk of heart disease and stroke, weight should be reduced to normal levels. If a person is overweight (BMI ie Wt in kgs/ ht in meters squared) and BMI is between 25 to 29.9 wt can be reduced gradually to with in limits. If a person is obese BMI >30 then more urgent weight reduction is required.

A weight reduction of about 10 kgs will make a substantial difference in diabetic control

Diet

If overweight or obese calories are cut down. About 15% calories should come from proteins and < 30 % from fats. The rest of calories may be from complex carbohydrates. Simple sugars are not advisable. Sugar substitutes can be taken.

If weight does not reduce after 6 months of trial, weight reduction tablets (Orlistat) etc may be considered. In severe obesity cases bariatric surgery may be the only alternative if all else fails.

Exercise

About 150 mins of exercise in a week is recommended. Aerobic exercises are preferred though in younger patients who do not have heart disease or advanced diabetic retinopathy weight lifting twice a week is encouraged.

The exercise should be done on most days of the week and be sufficiently vigorous to be of cardiac benefit.

Smoking

Smoking is a huge risk factor for heart disease. Since diabetes itself is a high-risk state for angina and myocardial infarction continued smoking increased the risk manifold. Smoking should be stopped totally to reduce this risk.

Drugs are required in nearly all cases for sugar control. More about drugs later.