|
DIABETES-TESTING AND CONTROL - A Patient's Guide
Editorial Team
Overview
Frequent blood glucose testing by people with diabetes
is important to help get good control and prevent long-term
complications. It is now known that good control of blood
glucose levels can prevent or reduce complications. A combination
of self testing and HbA1c testing is important to gain a
broad picture of diabetic control.
Why is testing important for diabetics?
Carefully monitoring of blood sugar levels (blood glucose)
gives valuable information to help obtain good control which
can delay the onset or progression of long term diabetic
complications.
People with type 1 and type 2 diabetes usually monitor
their blood sugar themselves using thumb prick blood tests.
Although most people understand their particular control
methods prevent day to day effects, they may not appreciate
how important self-monitoring is for long term health.
Frequent careful monitoring can show what may be happening
long term, and can show how positive changes to diet, exercise
or weight changes are improving a patient's diabetes. Close
monitoring of blood glucose levels - too high or low - allows
control of day to day effects, however this can also indicate
a changes over time and allow intervention to prevent diabetic
complications.
What are the long term complications?
The major long-term consequences of diabetes relate to
the damage of the blood vessels and nerves. Long term complications
of high blood glucose levels include loss of kidney function;
nerve damage and loss of sensation and circulation to extremities;
eye damage; and a higher incidence of heart disease and
stroke. These complications develop gradually over time
directly as a result of high blood glucose levels, so unless
levels are well monitored and controlled, the patient is
risking development of some or all of these complications.
Good long term control reduces complications.
Results of a long term study, the United Kingdom Prospective
Diabetes Study, showed tight control of blood glucose levels
markedly reduced complications. In the study, 3867 Type
2 diabetes patients were monitored over 10 years. Tight
control resulted in 25% reduction in eye, kidney and nerve
complications, and 10% reduction in diabetes-related deaths.
The study also indicated good control of high blood pressure
can help to reduce diabetic complications.
What are the vital tests?
As well as regular self testing and recording of blood
glucose levels by thumb prick blood tests, a few times a
year a laboratory test of HbA1c (glycosylated haemoglobin)
levels should be taken.
Other tests that are usually performed over time include:
urine test to monitor kidney function; blood fat levels
(cholesterol & triglyceride levels); and tests for kidney
function.
Regular blood pressure assessment and treatment when appropriate,
is needed. Examination of the feet by health professionals
is necessary as the patient may not be aware of loss of
sensation from early nerve damage. An eye specialist should
review eyes every 1 to 2 years, depending on test results.
What is HbA1c?
HbA1c (glycosylated haemoglobin) is collected in red blood
cells when they are produced. It gives an indication of
blood sugar levels over a couple of months - the average
lifespan of a red blood cell. As such it shows average blood
glucose levels over time, compared to the thumb prick test,
which indicates blood glucose at the moment of testing.
The combination of results from HbA1c tests and thumb
prick tests give a better indication of variations in blood
glucose levels than either test alone.
Why do self test meter readings sometimes vary?
Sometimes meter readings from self testing can vary, even
within minutes.
This may be due to the condition of test strips - these
are affected by light and temperature variations, so keep
them sealed in a cool dark place. Results may also vary
between manufacturers' products, so use one product. Test
strips have expiry dates - check these.
Different meters may work differently. It is best to use
one meter consistently to establish a pattern of results
to rely on.
Sometimes the first test may include skin products, and
the second, clotting compounds which both affect results.
Pay careful attention to washing and drying hands before
testing, and use a consistent test method.
It is also important to have meters checked and maintained
regularly, especially if results are changing.
How often should testing occur?
Diabetics on insulin control should self test 3-4 times
everyday, especially before bed. Type 2 diabetics on medication
control should self test around 3 times a day, a few times
a week.
If unwell, diabetics should test more frequently, likewise
if there are changes to exercise regimes or diet.
Good times to test during the day are first thing in the
morning, and before and after meals. Daily test times should
be varied to get a good picture of changes to blood glucose
levels right throughout the day.
What do test results mean?
Results of HbA1c tests show the average level of blood
glucose over a couple of months. If the HbA1c level is above
7%, options for diabetes management should be reviewed.
Recent stress or lifestyle changes may be taken into account.
Changes to physical activity, diet, and weight will all
be discussed and recommendations given where appropriate.
Injection technique or how regularly medication is taken
will be examined.
If the HbA1c level is above 8%, referral to a diabetes
specialist may occur, and medication may be altered or a
more intensive insulin regime used.
We would like to thank Extracare(New-Zealand),for access
to information in their newsletters.
|
