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Family Health Magazine
DIABETES

Managing Blood Glucose Levels
How often should you test?

This question is frequently asked of diabetes educators by people with diabetes. Unfortunately, there is no one answer that suits everyone’s needs. Those with diabetes test their blood glucose anywhere from many times each day to once a month. A diabetes educator could respond to this question with another question. “How often do you or are you able to test?” On the other hand, if a person with diabetes is directed to test two to four times each day there is little room for discussion even if once a week testing is desired.

It is important to work closely with your diabetes educator to decide what testing schedule is best for you. After determining how often you want or are able to test, your diabetes history is examined further. If you have been newly diagnosed with diabetes, the next step is to gather more information concerning your current goals for managing blood sugar levels. If you have had diabetes for several years, think about whether your blood glucose has been, or is, well controlled.

It is important to determine how your blood glucose varies throughout the day - when are the highs and when are the lows? What are the effects of meals and exercise on blood glucose levels? If you are taking diabetes medications, what are the effects of the medications? Are the medications effective? Figure out if the current “plan of action” or “treatment plan” is effectively keeping blood glucose levels in the desired target range. (Treatment plans consist of healthy eating, exercise and, likely, medications.)\

Why do we test?

We want to find out the following.

• Is the current treatment plan working?
• Are the medications effective?
• How do other medications affect blood glucose levels?
• How does a typical meal affect blood glucose?
• How do special meals affect blood glucose?
• Do the blood glucose levels fall into your goal range?
• How does exercise affect blood glucose?

When is it best to test?

People with diabetes generally test more frequently when first diagnosed. If blood glucose levels are out of goal range, you are encouraged to test more often. You may also test more frequently if your medications have been adjusted or treatment plans have changed. You need to be aware of the importance of testing more often when you are sick or under stress. Illness and stress can often cause blood glucose levels to rise.

What are goals?

People can develop good blood glucose goals by informing themselves about diabetes and understanding their needs. Get information by talking to a doctor, diabetes nurse educator, diabetes dietitian, pharmacist, and friends and relatives with diabetes. Read about diabetes in diabetes magazines, books and Internet sites. It is important to consider the source and accuracy of the information. Material promoting amazing results, difficult and expensive plans, or even a cure create false expectations and unrealistic goals.

You need to feel comfortable with your goal. If goals are set too far out of reach and are not achievable, you may be left feeling discouraged. Achieving goals requires a firm commitment. A diabetes educator will not create goals for you, but will help you develop your own goals. The Canadian Diabetes Association (CDA) has guidelines to assist people in caring for those with diabetes and setting their own goals. The guidelines have been included whenever possible in this article.

Fasting Blood Glucose

Let’s look at testing times and what they tell you. The first possible test of the day is the fasting blood glucose (FBG), also known as the fasting blood sugar (FBS). This test is done in the morning before breakfast, generally after no food has been eaten for eight hours. It gives you a starting point for the day.

The following are levels of glucose control for adults and adolescents with diabetes mellitus, from the 1998 Clinical Practice Guidelines for the Management of Diabetes in Canada. (Blood glucose levels for children are different. Their blood glucose levels should be discussed with a doctor or diabetes educator.)

FASTING OR PRE-MEAL GLUCOSE LEVELS (mmoL/L)

For a number of reasons, the fasting blood glucose level is often elevated in persons with Type 2 diabetes. Reasons include the release of glucose from the liver, and the number of hormones that are released in the early morning hours - glucose from the liver and the hormones cause blood glucose levels to rise.

After Meals

The next testing times are the postprandial or after-meal tests. The general rule of thumb is two hours after the meal. Testing two hours after breakfast gives a good indication of how well your body is responding to what you ate for breakfast. If it is higher than your goal, then look at the meal and see if there are any changes you can make to the meal. Review with a diabetes dietician is often needed. If there are no changes that can be made to the meal then exercise should be considered. Would a brisk walk after a meal improve the blood glucose levels? Medications may also need to be reviewed.

Check blood glucose levels before lunch and two hours after lunch, before supper and two hours after supper and also at bedtime. Use the guidelines above to improve blood glucose levels outside of the goal range.

GLUCOSE LEVEL ONE TO TWO HOURS AFTER MEAL (mmoL/L)

The HbA1c Test

We also look at a test called the HbA1c or glycated hemoglobin. This test, usually ordered by your doctor, gives a three-month indication of blood glucose control. The test measures the percentage of glucose attached to the red blood cell (imagine each cell gets a candy coating when the blood glucose levels are high). The CDA recommends testing every two to four months.

GLYCATED HEMOGLOBIN (%)

Often fasting blood glucose levels are normal but HbA1c is high. This indicates that the blood glucose has been elevated at a time other than breakfast. Many people only test before breakfast and may see near normal blood glucose levels. First morning blood sugar levels in target range is a great start, but if the HbA1c is elevated, it generally indicates that there are high blood sugar levels after the meals.

Testing Schedule

Testing blood glucose throughout the day allows you to look at the whole picture instead of just a small piece. Using a blood glucose testing schedule similar to the following example helps some people cover a large number of tests throughout the day during a one-week period. Most people feel comfortable testing twice a day for a short period such as one to two weeks. The asterisks (*) indicate testing times. If your blood glucose is elevated at a certain time of the day or after a certain type of a meal, you should consider repeating the test on another day at the same time. Keep in mind the effects of stress, illness, exercise and medications on blood glucose levels.

Record your blood glucose in a logbook. Extra logbooks can be picked up at any diabetes education clinic or Safeway pharmacy at no charge. There are a variety of logbook styles, so find out which one works best for you. Record the date, time of test, before or after a meal, and the blood glucose reading. A logbook allows additional information to be included which might explain high, low or just right levels.

Consider writing in exercise, changes in medication, special events (such as celebrations) and illness. This information assists you and your diabetes education team in mapping out the strategy to manage your diabetes. Blood glucose fluctuates for many reasons; testing allows you to gather the information needed to make informed choices. Discuss any concerns with your diabetes education team.