Self-control - what's the point?
Diabetes mellitus refers to those diseases that need to be monitored almost continuously. Obviously, it is impossible to continuously support your diabetes with a doctor and therefore a fairly large part of the responsibility for the quality of diabetes treatment today lies with you. This is called "diabetes self-control." To control blood glucose at home, technical tools have been developed, first of all, blood glucose meters - devices that allow you to get information about the level of blood glucose in a minute or less.
Due to the self-monitoring of blood glucose, it is possible to recognize in time and avoid an acute increase in blood glucose, severe life-threatening metabolic disorders (ketosis, ketoacidosis) or a rapid and significant decrease in blood glucose (hypoglycemia). When changes in metabolic indexes are regularly recorded in the so-called diabetic diary, thanks to the clarity, it is easier for you and your doctor to orient yourself in the current situation and decide whether to change the previously prescribed treatment and to what extent. Your long-term glucose indicators have made it easier for you to interact with your doctor; moreover, the results of previous attempts to adjust the treatment make it possible to avoid previously made mistakes. Failure can also learn!
When you change the diabetes treatment regimen or even keep it unchanged without self-monitoring of blood glucose, you behave like "a ship sailing for good luck in the sea, without a map and a compass".
Only by self-checking blood glucose and the adjustment of treatment based on it, can the development of the undesirable effects of diabetes be avoided or at least significantly suppressed.
Modern blood glucose meters automatically record the level of blood glucose that you measure, which you can download to a computer and get a visual representation of the long-term quality of diabetes treatment. Some meters have a built-in program that allows you to choose the optimal insulin dose for you. That is, modern glucometers are gradually turning into a mini-computer, which gives reasonable advice.
Today, Internet technologies have been developed that make it easier for you to analyze the results of regular blood glucose tests.
In the urine, it is necessary to periodically examine the protein content (microalbuminuria), for the study of which in the pharmacy you can purchase special test strips. Its early detection allows you to prescribe treatment and save kidney function.
It is also recommended to regularly check blood pressure and blood cholesterol for the prevention of heart attack and stroke. For this purpose, special blood glucose meters have been created, which, in addition to blood glucose, determine the blood cholesterol content. This is especially true for T2DM, which predisposes atherosclerosis.
Blood glucose control - basic principles
Regular monitoring of your blood glucose is usually referred to as glycemic monitoring for short. So, the specified monitoring is a very important element of effective control of your health and diabetes. Currently, blood glucose monitoring is broken down into two components:
- Rapid blood glucose testing with a glucometer up to several times a day. And this is your task, that is, a person with diabetes. According to the results of this study, the current treatment regime for diabetes is determined and changed, if necessary. First of all, by you and if unsuccessfully - with the help of your doctor.
- Evaluation of the results of diabetes treatment on average for 2-3 months. By level A1c. This study is performed in a laboratory and the results are evaluated by your physician. Depending on them, a long-term, in the coming months, strategy for treating your diabetes is determined.
The determination of blood glucose helps you understand how to behave in the situation that has arisen due to food intake, acute illness or during stress. Depending on the level of blood glucose, the dose of insulin and other drugs, the amount of food and physical activity are adjusted. In any case, including monitoring in a diabetes management plan allows you to maintain a good state of health for a day and prevents the development of late complications of diabetes.
Who should monitor blood glucose?
The answer to this question is simple - you! If you are assigned insulin, then you must constantly monitor your blood glucose. In type 2 diabetes, when insulin is not needed for its treatment, you determine the mode of blood glucose testing with your doctor. Insulin and other hypoglycemicdrugs very actively reduce blood glucose levels. You can check how well they work by monitoring blood glucose. Keep in mind that these drugs can cause a sharp drop in blood glucose, that is, cause hypoglycemia. Monitoring allows you to know for sure if your poor state of mind is not the result of low blood glucose levels. And, moreover, based on the results of monitoring, you can determine how much and what kind of food you need to eat at the next reception.
If you have type 2 diabetes or gestational diabetes and your treatment consists only of dieting and increasing the amount of physical activity, then you do not need to worry too much about frequent blood glucose testing. But the study of glucose from time to time - very useful, and glycatedhemoglobin (A1c) once every 3-6 months. So simply. It is A1c that allows the doctor to evaluate whether it is still enough to cure your diabetes dieting or is it time to add glucose - lowering drugs.
The best way to maintain your health is to regularly monitor your diabetes. You can do this by adjusting your blood glucose levels with diet, physical activity and medication. The only and most important rule that must always be followed in diabetes is to regularly monitor blood glucose levels. Monitoring is the only way to find out how your body reacts to food intake, medication, and physical activity. Without information about this, you cannot adjust your treatment plan so that it remains the best for your health. Through a series of small experiments with the regulation of blood glucose, you can ultimately reach the target value of blood glucose and constantly maintain it by monitoring glycemia.
How often should blood glucose be monitored?
Obviously, the frequency with which blood glucose is monitored is very individual. First of all, it depends on the type of diabetes - 1 or 2, blood glucose targets, how often you are ready to prick your fingers and how much your salary allows you to provide yourself with the means of self-monitoring of blood glucose (test strips and blood glucose meter), which are not cheap. The frequency of monitoring is also influenced by your belief in the benefits of this procedure.
You may have type 1 or type 2 diabetes that you need to use the monitoring results to calculate the insulin dose and the amount of food you eat. Then the study of blood glucose should be done before each meal and the injection of insulin, at least, a short action. And this is 3-5 times a day and, naturally, daily. It may be necessary to control blood glucose after meals. In this case, the number of studies of blood glucose levels increases even more.
If the goal of treatment is to maintain the blood glucose level close to normal values on the background of insulin therapy, then the number of mandatory studies should be at least four and sometimes reaches eight per day, and every day. In this case, the blood glucose level is examined before each meal and after it, as well as before going to bed each day and, moreover, in the middle of the night (about 3 hours) about once a week. Special studies have shown a direct relationship between the frequency of blood glucose testing and the quality of treatment for type 1 diabetes. In more detail, ways to maintain blood glucose values as close to normal as possible will be discussed in subsequent chapters.
You may be given infrequent administration of insulin — once or twice a day, or just tablets that have hypoglycemic drugs. In this case, it is enough to examine blood glucose 2 times a day. However, in type 2 diabetes, the blood glucose level is more stable than in type 1 diabetes. The treatment of glucose - lowering drugs with pre- treated glucose is even lower, as these medicines do not regulate blood glucose levels very quickly and easily, as in the case of frequent insulin injections.
If in case of diabetes mellitus type 2 there is no need to take any medication, and dieting is sufficient, then blood glucose is usually tested 1-2 times a day and no more than 3-4 times a week. Nevertheless, regular blood glucose testing, even in this case, will allow you to keep your diabetes under complete control and see how effective your efforts are. In the case of rare blood glucose tests, on some days you can examine the fasting blood glucose level or just before breakfast. On other days - before lunch and dinner, or after a meal or after exercise. As a result, you will get a fairly complete picture of the regulation of blood glucose levels throughout the day.
Standard blood glucose measurements:
- Before breakfast, lunch and dinner, and also before a rich "snack".
- Before bedtime.
- After 1-2 hours after breakfast, lunch or dinner, as well as a rich "snack".
- Between 2 and 3 o'clock at night.
Sometimes for reasons unknown to you, your health deteriorates. Glycemia monitoring can help you find the cause of this. For example, if you have severe sweating and a slight shiver in your body after jogging. This may be a normal reaction to intense physical exertion, and may be a consequence of low blood glucose levels. It is impossible to determine this without a blood glucose test. Without knowing the level of blood glucose, you can assume that its level is low and quickly start eating. But in fact, glucose levels can be high, and the food will increase it even more. Only the study of blood glucose allows in such cases to make the right decision.
After all, by regularly researching blood glucose, you will become an expert in your diabetes. Having become proud, you can decide that it is not necessary to monitor glycemia as often as before. By no means! If you think that you can determine your blood glucose level due to your well-being, then you are mistaken. A specially conducted research in this direction showed that no one with diabetes can reliably determine his blood glucose level only on the basis of his feelings. Divination regarding the possible level of blood glucose is very dangerous, especially if your blood glucose level fluctuates significantly during the day and these fluctuations show little in the form of special sensations.
When is additional diabetes control needed?
There may be situations when you need to examine blood glucose more often than usual, for example, you find yourself in some unusual, new situation for you and have to determine how it affected the blood glucose level. This is usually a change in drug treatment, nutrition, physical activity, stress, or acute illness. All of them have an effect on blood glucose levels. Thus, in these situations, more frequent blood glucose testing is needed. This additional control will help you to adequately correct the deviation of blood glucose from the target values. Remember that you should always monitor blood glucose levels if you suspect that your blood glucose is either very high or, conversely, low.
Additional glucose monitoring and food. It must be borne in mind that some foods may cause you to have a noticeable increase in blood glucose. But in order to find the right solution, you need to keep only a few important indicators in mind. Blood glucose levels are affected by the amount and type of carbohydrates in the product, as well as the amount of product in the food you intend to consume. Sounds complicated, huh?
The best way to do this is to start exploring how the foods you consume affect your blood glucose levels. You can research blood glucose more often when you decide to eat a new product or dish. In this case, you may be very surprised at how your blood glucose level responds to taking different foods. It is advisable to examine the blood glucose level in 1-2 hours after eating a certain food. If you know how your blood glucose reacts to certain foods (potatoes, rice, etc.), then you can create a menu for yourself against which the fluctuations in blood glucose levels will beminimal, without a significant and rapid increase. More on this in the following chapters.
Additional monitoring during exercise. As a rule, physical activity, including exercise, reduces your blood glucose level and increases your body's insulin sensitivity. This is due to the fact that during exercise muscles use glucose as a source of energy for the implementation of increased physical activity. And they draw this glucose from the blood. In this regard, you should take some precautions when exercising. You must be sure that with this the blood glucose decreases not too fast and low. Moreover, this can occur immediately after the end of the load, or even several hours after it is completed, as the muscles continue to use increased blood glucose in increased amounts to replenish previously produced energy costs. Additional study of blood glucose after exercise will allow you to determine whether you need to increase food intake or reduce the insulin dose, for example. In type 2 diabetes, some may find that regular exercise can keep their blood glucose levels in a good range with less or no insulin. But at the same time keep in mind that you should definitely discuss the possible correction of the diet, insulin doses or other drugs with your doctor.
Additional monitoring on the background of new drugs or insulin. If you have type 2 diabetes and you are taking tablets of hypoglycemic drugs, then finding the best treatment can be quite a challenge. When prescribing a new glucose - lowering drug or changing the dose of such a drug, it is necessary more often than usual to examine the level of blood glucose. First of all, you need to examine blood glucose 1-2 times a day (before breakfast and once at a different time of the day) in order to avoid low blood glucose levels. It may be necessary to examine blood glucose 2 hours after a meal in order to determine the effect of nutrition on blood glucose levels. Glycemia monitoring will help you and your doctor determine the effectiveness of a change of treatment and the need for additional therapeutic actions.
Purpose of insulin or change of the mode of treatment by insulin also assumes more frequent research of blood glucose.
Other additional monitoring cases:
- Driving (in case of insulin treatment)
- When physical activity is higher than normal
- When weight decreases or rises
- When drugs are prescribed not from diabetes, but from another disease, but which affect the blood glucose level or disrupt the perception of symptoms of low blood glucose levels (hypoglycemia)
- On an empty stomach, the blood glucose level was unexpectedly high, which is often a response to hypoglycemia at night or in the early morning before waking up.
- If the blood glucose level is more often outside the target values than within them
- If you feel unwell. A blood glucose test will help you understand its cause
- When pregnancy
Additional monitoring during stress. Stress provokes many vital factors - negative emotions, colds, injuries and everything that differs sharply from the ordinary course of life, causing you mental and physical stress. Against the background of stress, hormone production increases, which prevent the action of insulin and, accordingly, against the background of it, the blood glucose level rises. In this regard, glycemia monitoring should be carried out more often when you are in a stressful situation. The effect of stress on blood glucose cannot be measured as easily as insulin units or calories that burn during exercise. At the same time, during stress, blood glucose usually goes beyond target values, and this should be monitored, on the one hand, and corrected promptly, on the other.
Additional monitoring during acute illness. Any acute illness (cold, etc.) is also stressful for the body. Increasing the level of hormones in the blood helps the body to cope with the disease, but at the same time the effect of insulin worsens. As a result, the blood glucose level rises. If it is not reduced in time, it can lead to a very significant increase in blood glucose, and to such an extent that it may require urgent hospitalization in the intensive care unit (intensive care unit). Such situations are the most common cause of diabetic coma (loss of consciousness) and death from it. Even if you have type 2 diabetes, in which you didn’t often study blood glucose before an acute illness, in the case of an acute illness, you should examine it 3-4 times a day, every day.
Conclusion In this book you will find many tips on how to use the results of self-monitoring of blood glucose. They will help develop the best treatment plan for your diabetes, in particular diet, physical activity and medication. Sometimes the results of a blood glucose test are needed to make an immediate decision about the insulin dose or food intake. In other cases, the results accumulate, especially when controlling type 2 diabetes without insulin treatment, when rare blood glucose tests during the day ultimately after a week or more give a true idea of the effectiveness of the treatment. Self-control is also indispensable for taking emergency measures to normalize the blood glucose level (hypoglycemia, for example).
Means of self-control of diabetes
After reading about the importance of blood glucose testing at home, you probably want to know exactly how this research is done at home, at work, or in other places where you usually go. Currently, a rather extensive selection of blood glucose self-monitoring means is offered that make this task extremely simple. They are compact and reliable, and about thirty years ago, a diabetic patient could only dream of such devices.
These devices continue to be improved and it is almost impossible to cover the whole range of them. But there is a certain minimum of technical means necessary for conducting a blood glucose test directly by you:
- Lancets: devices that are designed to pierce the skin with a small needle in order to get a drop of blood from a finger.
- Test strips: thin oblong rectangular strips of special material, which is applied a drop of blood and which are then inserted into the meter.
- Meter: small, about the size of a cell phone device that determines the concentration of glucose in a drop of blood deposited on the test strip.
- Diabetes Monitor Daily: your blood glucose records. Someone keeps records on paper (usually special diaries), and others - on electronic ones.
Lancets allow you to get a drop of blood from a finger with a minimal discomfort from the injection, but at the same time to the extent necessary for the study of glucose in it. The lancet is , in fact, a needle, which is bricked up in a plastic sheath. The lancet is inserted into the trigger. This device looks like a pen in which there is a spring, and in the case of a trigger button. A device loaded with a lancet is put to the finger, the start button is pressed - and the skin of the finger is punctured by the lancet. A drop of blood (capillary) appears in the injection site for examination. The puncture of the skin is practically painless and quickly heals without scarring.
In some cases, the blood for research can be taken not only from the finger - from the earlobe, for example. The so-called needle - free devices for capillary blood, which are used by those who are very afraid of injections, have been developed.
Lancets are sterile only before first use and therefore should not be reused by anyone. When reused, lancets become blunt and the shots become painful. Launchers for them, too, are purely personal objects and should not be lent to anyone. Lancets are not suitable for every launcher - pay attention to it. Chargers are sold separately from the lancets and therefore pay attention not only to the price of the device, but also the lancets to it. Lancets can be purchased at a pharmacy or online store.
After a drop of blood has come out from the lanceolate incision, it should be placed on a so-called test strip. Then the test strip is inserted into the device, which determines the concentration of glucose in the blood. This device is called a glucometer. So, test strips are needed for taking blood and then used in blood glucose meters. Please note that each meter can work with only one specific type of test strip. Production of blood glucose meters and test strips are closely related processes - the same company produces test strips and blood glucose meters specifically for them! With modern glucometers, the sequence of work is usually the following:
- The test strip is inserted into the meter that includes it.
- A finger is punctured by a lancet and a drop of blood is obtained.
- Blood is applied to the test strip inserted into the meter.
- The meter on the display shows the blood glucose concentration within 1 minute.
Continuous blood glucose test
The main part of the device, which continuously measures (monitors) the level of glucose is the so-called sensor. Its dimensions are microscopic and it is injected under the skin, into the fatty tissue. At the injection site, he measures the concentration of glucose between the fat cells (in the interstitial fluid) and transmits this data to a miniature computer worn on the body. Since the concentration of glucose in the interstitial fluid depends on the concentration of blood glucose, the computer calculates the level of blood glucose indirectly, but quite accurately, from the level of glucose in the interstitial fluid. Depending on the type of device, the information on blood glucose every minute or at five-minute intervals appears on the display.
On the display of modern devices not only the current value of blood glucose is recorded, but also the direction of change in its concentration - decrease or increase. As well as the rate of change of blood glucose. If the blood glucose level goes beyond the limits or the rate of change of blood glucose exceeds the specified limit, the device sends a signal. The devices are also equipped with special computer programs that produce graphs of changes in blood glucose per day, as well as the characteristics of these curves (average daily value of blood glucose, the duration of blood glucose outside the limits of acceptable values, etc.).
However, these devices and sensors for them (which should be changed, depending on the type 1 time in 3 or 7 days) are very expensive. In addition, the indications for their use have not yet been sufficiently developed. Moreover, recently it has been proposed to even change the principle of selection of insulin therapy in the case when this device is used. Instead of orientation, as in the self-monitoring of blood glucose, to glucose level, it is recommended to take into account the rate of change of blood glucose and the direction of this change. A certain benefit is noted for those who wear these devices constantly and highly motivated for such treatment.
So, for wide application, these devices are not yet suitable. Moreover, the use of this device does not preclude blood glucose testing with a glucometer. On the contrary, it is mandatory up to 5 times a day, since the device is calibrated during the day according to the level of blood glucose, determined by the glucometer. Probably their greatest prospect is a combination with an insulin dispenser and automatic control of the insulin supply dispenser according to the results of a continuous glycemic test. But in this direction only a few scientific studies are presented, although the results of such treatment are very good.
Diabetes control diary
One of the most important means of controlling diabetes, which is often ignored, is the Daily Diabetes Monitor. Its appearance does not have to be presentable. The main thing is that it should help you and your doctor to get a correct and clear idea about the level of blood glucose over a long period of time. It is usually marked and problematic indicators of blood glucose (significantly lower or higher than target values), which allows time to take appropriate corrective measures of glucose-lowering treatment.
You can get a standardized "diary" from an endocrinologist or the "School of Diabetes" or it can be supplied with a meter that you purchase. In some cases, manufacturers of blood glucose meters provide a "diary" in electronic form, which you can download to your computer and print. It can also be downloaded from the Internet.
Its main part looks very simple if it does not mark the dose of insulin and the amount of carbohydrates taken.
Teats on ketone bodies
More often with diabetes of the first type and very rarely with diabetes of the second type a life-threatening condition called ketoacidosis develops. In this case, so-called "ketone bodies" appear in the urine. Its cause is severe insulin deficiency, which is more characteristic of type 1 diabetes than the second. In this regard, ketoacidosis is characterized not only by the appearance of ketone bodies, but also by a very high level of blood glucose. Signs of ketoacidosis include nausea, vomiting, abdominal pain, the smell of acetone in exhaled air, and accelerated breathing. If treatment is not prescribed in a timely manner, then coma develops, and then death. This condition is most often caused by acute infections, stress, or cessation of the introduction of glucose-lowering drugs. drugs. The initial signs of ketoacidosis can be controlled by examining urine for ketone bodies. This is discussed in more detail in the next section.
The study of ketone bodies in the urine is made using test strips, which can be purchased at the pharmacy.