HELP ON DIABETES

Monitoring Glucose Levels

Glucose levels in people with diabetes fluctuate much more than those of people without diabetes. In people without diabetes, fasting glucose levels in the morning are usually between 60 and 100 md/dl. Before each meal, the levels are below 100 mg/dl. The peak values one to two hours after a meal are in the 120's and usually below 140, even after a meal rich in carbohydrates.

It is difficult to achieve normal glucose levels in diabetes. Even when levels are below 100 mg/dl before meals, they frequently go above the 140 range after meals. This is especially true if one take insulin, in which case aiming for normal glucose levels can significantly increase the risk of hypoglycemia. The only time doctors attempt to achieve normal glucose levels in insulin-treated patients is during pregnancy, when the target for premeal blood glucose level is 60 to 100 mg/dl, postmeal peak level (usually about one and a half to two hours after a meal) is less than 130 mg/dl, and bedtime and 2 A . M . levels are around 100 mg/dl.

If you are insulin-treated and are not pregnant, your doctor will aim for premeal glucose levels between 90 and 130 mg/dl and postmeal levels less than 180 mg/dl.

UNDERSTANDING HOME MONITORING

Blood glucose monitoring at home is an important part of diabetes management and serves a number of purposes. First, monitoring at home makes it easier to detect low blood glucose reactions. When aiming for the glucose targets, many peo­ple with diabetes develop hypoglycemic unawareness, meaning they can have glucose levels in the 40s and 50s and still feel quite fine. For this reason, measuring glucose levels frequently allows detection and treatment before the glu­cose levels fall too low. This monitoring is particularly relevant when exercising or when performing activities such as driving or operating machinery, when one need to be alert.

Second, home monitoring allows to detect high glucose levels. Elevated glu­cose levels may reflect dietary indiscretion or failure to take or to adjust diabetes medications. If you are on an insulin pump, there is not a big depot of insulin in the subcutaneous tissues, and if for any reason the insulin delivery gets interrupted, glucose levels can go very high and DKA can develop over a few hours. Persistently elevated high glucose levels increase the risk of developing long-term complications of diabetes.

Finally, home monitoring allows you to adjust medication doses, particularly insulin. If you’re an insulin-treated patient, check your blood glucose levels at least four times or more a day. If you have type 2 diabetes controlled with diet only or are on medications that do not cause low glucose levels (for example, metformin, pio­glitazone, rosiglitazone, or exenatide), checking blood glucose levels a few times a week may suffice. However, if you have type 2 diabetes and are taking oral medi­cines that can cause low glucose levels (sulfonylureas, repaglinide, and nateglinide), one or two blood glucose checks per day are necessary.