As with most people who have diabetes, you must have been warned about the dangers of an unhealthy diet, excessive calorie consumption, lack of exercise. Your doctor probably sat you down and explained to you about the dangers of high blood sugar and what you need to do to control it to manage your diabetes better. How does one check if those extra vegetables, those long walks and new medications are helping?
The most effective way to do this is to regularly monitor your blood sugar levels, known as self-monitoring of blood glucose (SMBG). These values can guide before you go back to your doctor with laboratory tested fasting and post-meal blood sugar values and your HbA1c (glycosylated haemoglobin) and gave your doctor in-depth information regarding your status in-between visits.
What is SMBG?
Self-monitoring of blood glucose (SMBG) refers to the testing and recording of blood glucose levels by a patient and/or caretaker, at home or in hospital, at different times of the day. Usually, these are done either before meals or two hours after meals as that is the amount of time after a meal that the blood glucose levels are supposed to come back almost to pre-meal levels. Normal fasting or pre-meal values should be around 90-130 mg/dl, and peak postmeal values should be less than 180 mg/dl. However, individual customised targets will be set for you by your doctor depending on several factors like age, duration of diabetes and comorbid conditions like kidney or heart problems.
Patients need to be careful about to check their fasting blood sugars without looking at post-meal values. Lifestyle and self-monitoring of blood glucose data make great partners. Adding additional information with self-monitoring of blood glucose like meal details, portions, meal timings, exercise frequency and duration further helps the doctor refine your treatment by studying the impact of both food and exercise on your blood sugar levels. Checking your blood glucose levels regularly can help both you and your doctor understand how well exercise, diet and medication are working together to keep your blood glucose under control. All these elements are part of the ‘diabetes care’ plan that your doctor will have drafted for you, and it is unique to every patient. Depending on the fluctuation in your blood sugar levels, he/she may adjust this plan and advise changes.
Another great use of self-monitoring of blood glucose is to assess diet’s impact on your blood sugar level. Let me give you an example. Usually, in most Indian homes, different breakfasts are cooked every day like chapati, poha, upma, idli, dosa, thalipeeth and puris. The variety is endless. Suppose you check your post-meal sugar after eating chapatis and it is at a balanced level. Your doctor sees this report and decides that all is well. However, if you eat deep-fried puris, your blood sugar levels will rise, and you may require more insulin. Essentially, diet customisation helps us understand how your body responds to a certain type of food and thereby help you modify your insulin dose depending on what foods you are consuming.
Special situations – type 1 diabetes mellitus
Patients with type 1 diabetes experience higher glucose variability leading to a greater risk of hypoglycemia or a sudden drop in blood sugar, making it imperative to monitor their blood sugar to prevent this situation continuously. The hypoglycemia may often be asymptomatic, and unless the patient has checked their blood sugar, they may slip into unconsciousness without any premonitory symptoms. Research has shown that insulin therapy guided by frequent blood glucose monitoring shows a better outcome for type 1 diabetes patients than for patients undergoing insulin therapy without closely monitoring their blood sugar levels.
Easy ways to track, record & monitor
Recording your blood sugar levels for your doctor’s review goes a long way in ensuring optimum diabetes management. However, maintaining a log of your daily results can be cumbersome and inconvenient. This is where digital therapeutics platforms or applications come into play. These are very reliable, easy to use, and can help you record your blood sugar and remind you to do so! Some platforms even suggest a doctor visit if your blood sugar is dangerously low or high. These applications can become a database and help you map when your blood sugar level dropped or rose over a period of time, thereby helping you ascertain what actions may have contributed to the same.
Self-monitoring of blood glucose protocols (intensity and frequency) is normally customised to address each individual’s clinical requirements to monitor certain medications’ effectiveness and prevent hypoglycemia or hyperglycemia. Doctors usually recommend frequent self-monitoring of blood glucose for patients on multiple daily insulin injections, patients with a history of hypoglycemia and if the insulin has been prescribed for pre-gestational/gestational diabetes. Patients on multiple doses of insulin or insulin pumps should test themselves three or more times daily (pre-meals, post-meals, bedtime, prior to exercise). Pregnant women with insulin-treated diabetes are advised to perform frequent self-monitoring of blood glucose similarly.
Listen to your body!
You must take a close look at your record to see if your blood sugar levels are too high or too low for several days in a row. If it keeps happening, it might be time to contact your doctor for fresh advice on your diabetes management plan changes. It is also important for you to ask your doctor if you should immediately report results out of a certain range.
If you experience light-headedness, dizziness, confusion, headaches, sweating, these might be signs of hypoglycemia. This could occur if you missed an insulin dose, had an inadequate meal or participated in strenuous exercise or physical activity. In such cases, you should contact your doctor immediately.
The next time you test your blood sugar and are upset with the results, don’t get overwhelmed. Listen to what it’s trying to tell you carefully, catch up with it a couple of times a day through your monitoring, report back to your doctor and often, you’ll be pleased with the outcome.