A practical look at self-monitoring of blood glucose

Abstract

Abstract Being able to check their own blood glucose levels can enable individuals with diabetes mellitus (DM) to better understand and manage their illness. Intensive glycemic control has been shown to reduce the long-term microvascular complications of DM. The goal of this article was to provide an overview of self-monitoring of blood glucose (SMBG) and its role in the management of DM. Relevant articles were identified through a literature search of MEDLINE from 2000 to 2006 (English-language articles only). Search terms included blood glucose, self-monitoring, and glucose monitoring. Materials also came from the author's own collection of journals and articles. Case studies are provided to illustrate some issues that arise in DM management. For patients receiving multiple insulin injections, SMBG should be done ≥3 times per day. SMBG has been shown to be a useful tool in helping patients achieve their glycemic targets. Blood glucose may improve when a patient is on insulin, and SMBG guides the provider and patient in making changes to insulin therapy and dosing. Unfortunately, more thorough examination of SMBG in non-insulin-treated patients is needed to demonstrate its usefulness in this population. Cost can sometimes be a barrier to SMBG use, as insurance companies and Medicare may have specific restrictions on how often certain supplies can be purchased. In addition, glucose monitoring requires a particular level of literacy, dexterity, and judgment to conduct a proper test and interpret the results. Although the accuracy of the meters can vary, the following factors can help ascertain an exact reading: proper storage of the meter and strips; thorough instruction of the patient in the correct techniques for obtaining a blood sample; and the use of alternative site testing. Various patient groups (eg, children, the elderly, the visually impaired) may require different meters. Individualization of treatment and education is necessary for any patient with DM, and SMBG can be used to help make treatment decisions, such as amount of insulin to take; to identify hypoglycemia or hyperglycemia; to determine the effect of food, medicine, stress, or activity on blood glucose; to manage blood glucose during illness; and to recognize patterns in blood glucose trends. Although SMBG can be a valuable tool for individuals with DM, its true usefulness lies in what is done with the results. With education, people with DM can learn to make appropriate lifestyle choices and communicate more with their health care provider to achieve optimal glycemic control.