Reliability
of glucometer
More than twenty five
years have elapsed since the
introduction of glucometer During this
period technology has been continuously
updated and deficiencies found to earlier meters have been gradually overcome.
The modern meters are reliable provided
one understands and follows the instructions mentioned in the manual
stores the strips properly and avoids using outdated
strips . It must be noted that
with glucometer capillary whole
blood is tested for glucose while
during laboratory test venous
plasma component of blood is
tested for glucose While in fasting
stage glucose levels in capillary
whole blood and venous plasma are more or less equal in the fed state level in former is about 20 mg% higher
than later. Even after accounting
for the above mentioned difference up to
15% difference between
capillary whole blood values and laboratory test acceptable. Thus one need not doubt reliability of glucometer if he values
of laboratory test and glucometer
reading done at the same time are not identical However glucometer requires periodic cal liberation.
This can
be done every two to three months by simultaneous testing of blood glucose
in laboratory and with glucometer
. One should also remember that Hypo
perfusion and anemia affect
capillary blood glucose Former give false
low values while later results in to false high values. Family
physicians should also strongly
recommend glucometer to all the
diabetic patients for self
monitoring of blood glucose.
How & who will train the person or family member if she
is too old. Training the patients using glucometer
1)
Frequency
of self monitoring of blood glucose
The frequency of SMBG
depends on several factors such as sub
type of diabetes degree of stability of blood glucose presence of special situations In stable and well controlled type 2 diabetes
SMBG is required once or twice
a week while in type 1
diabetics those diabetics on insulin those with brittle blood glucose control and in pregnant are rough guidelines which will require modifications in an individual case
2 ) Timing of blood glucose examination
Routine tests
The timing of blood
glucose will depend on individual case.
a) The usual test timings are pre meals and post
meals . Usually initially emphasis is on pre meal monitoring and adjustment of
dosages of anti diabetic medications based on pre meal blood glucose values
.
b) post meal monitoring Once these are stabilized attention is shifted
to post meal monitoring One also has a choice of estimating premeals and post
meal values on the same day.
c) One can plan to test the blood glucose at different
times in a rotating manner e.g. on Monday pre breakfast post lunch and post
dinner blood glucose estimation.
d) on insulin therapy :-In addition to pre and post meal
estimation occasionally particularly in those
on insulin one should test at 3 am . These values give more precise idea
about the level of overnight control and help in taking correct decision
regarding adjustment of pre dinner and bedtime insulin dosage. In some patients
particularly with relatively large dose
of pre dinner intermediate acting insulin early morning blood glucose dips in
hypoglycemic range and reactive hyperglycemia occurs in morning as a result of
early morning hypoglycemia. This vicious cycle
can be broken by detecting early morning
hypoglycemia and making appropriate changes in insulin dosage.
f) SOS tests when :
In addition to the test
timings mentioned above patients should be advised to do random blood glucose
estimation in following circumstances
Q.
24:-What are the symptoms or signs of hypoglycaemia?? What wrong steps one can adopt
during this hypoglycemic attack specially in old women /men who can’t read
capillary glucose due to tumbling of their hands or due to poverty not
possessing own glucometer(often the
paper strips are exhausted and sons and daughters are abroad). Ans;- What steps are wrongly
done more so if a diabetic person resides alone or sleep alone in a winter
night ?? Quite often such symptoms are taken
lightly and she/ he goes to sleep again
and die out of H attack. Or another
mistake is to consider these as panic/ mania and consider these symptoms of real
hypoglycaemia as anxiety related symptoms and don’t take aggressive management.
In the process However anxiety
related non specific symptoms are also common in the community including in
diabetic patients.
Hypoglycaemia if the concerned woman is alone at home but she
is educated. In such settings timely SMBG
(self monitoring of capillary Glucose can saved her. Anxious diabetic patients who do not have
glucometer or don’t use it during sudden symptom are likely to be caught in a
trap if they interpret their anxiety related symptoms as those duet to
hypoglycemia and reduce the dose of their anti diabetic medications without
consulting their doctor and avoid doing a lab blood glucose test. They also eat
snacks very time they get these symptoms disappear on their own however since
they have taken a snack they assume that they really had hypoglycemia. These
non indicated called for actions lead to hyperglycemia and exposes them to the
complications of diabetes.
1)
The
usual symptoms of hypoglycemic attacks are such as hunger, palpitations, sudden
sweating. Giddiness etc. These symptoms
could be due to hypoglycemia which needs to be confirmed or ruled out on the
spot. Thus timely SMBG (self
monitoring of capillary Glucose) =can save precious time and life as well as lots of money by
avoiding delay in hospitalization in case of serious condition such as heart
attack or by avoiding unnecessary
hospitalization in cs of simple
hypoglycemic episode. Prompt use of glucometer and SMBG ans swift appropriate
action in only one episode will
more than compensate for the entire
investment cost of glucometer.
Recording of SMBG data:
It is important to enter
each blood glucose value along with date
time and appropriate comments neatly in
tabular form and take the data at every consultation visit. This
data along with the periodic laboratory blood glucose tests helps
the treating doctor for fine tuning of anti diabetic medication
dosage. Patients should be advised to contact you if two successive readings are out of range so that
you can take timely action. This is the precise purpose of doing periodic SMBG (self monitoring of capillary Glucose
Those who do not do periodic SMBG(self
monitoring of capillary Glucose miss the opportunity to correct
blood glucose fluctuations in mid
course. Their blood glucose values
remain out of range till they do
laboratory blood glucose test. Every day of abnormal blood glucose
increases the chances of developing
complications of diabetes
Take home message from Dr S K Pal on
DM who are treated by us
If family physician can treat and mange DM why
not we!!! At all emergency deptt9ER) the
general duty medical officer must have his own properly cal liberated and functioning glucometer
all the time with him in the
clinic as well as on the emergency visits. He should also encourage self
monitoring of blood glucose by the
patients. So also at outré clinic we must have own glucometer & pulse
oximtery nowadays.
Are you feeling
sleepy after reading these notes. Then omit supper & go to sleep. Send the
supper to this old man. Drugs used in DM
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