T2D SMBG

Submitted by Thiruvelan on Tue, 10/22/2013
Type 2 diabetes self monitoring blood glucose

The type-2 diabetes control is in your hands and literally, at your fingertips. Test, analyze, modify, and test again until reaching your target BS.

Self-Monitoring Blood Glucose in Type 2 Diabetes

You should check your fasting that is before eating anything to check the liver. Moreover, two hours after start eating your meal to check how well your body is responding to food.

Keep a written log for what you eat, and your BS tests result. Your meter can keep the reading in its memory. These readings are no meaning unless you relate to what food influencing how much BS. Write down what food, how much and match it to the BS respond it makes. It helps you to find enemy foods (produces higher BS spikes) and replacing it with friendly foods (makes lowest BS spikes).

Next, find out when your BS peak spike happens after eating. Start testing at 1, 1.5, 2, and 3-hours after eating (do these for all three meals). Learn at which time your highest spike occurs; this is the time you will do postprandial testing in the future. There is a peck at 30 minutes after eating that is no importance because studies confirm that will not increase diabetes complications.

My A1C is below 6.5%, why should I SMBG?

Most type-2 diabetes (even their healthcare providers) on seeing their A1C of less than 6.5% might be a good blood sugar number. Thus, they may think about why they should spend money, time, and effort of BS testing. However, the truth is the A1C is the average glucose of 24 hours a day, for about three months past. An average may contain both highs and lows; it is common to have an A1C of less than 6.5% with blood sugar highs at 200s and lows at the 50s. You may shock to hear still this may be the truth.

Why, when, how, and what is blood sugar testing?

Blood sugar testing is essential to manage your diabetes and stop its complications. For type-2 diabetes, there is no emphasize for BS testing; thus, they are more likely to get early diabetes complications than type-1 diabetes. A study shows people with type1 diabetes develop diabetes complications after 15 years, whereas people with type2 diabetes may develop diabetes complications after ten years.

Why do you need to test BS?

Blood sugar testing or self-monitoring of blood glucose can help you how well your diabetes treatment is going on. Help learn how your diet and exercise influence your blood sugar levels. Discover how an illness & stress can disturb your BS. Know how your medication maintains your BS and identifies and prevents hyper & hypoglycemia.

Why should I take both fasting and postprandial blood sugar?

When type2 diabetes patient has a raised fasting blood sugar, does not mean anything about the diet for the day or night before, why? Because the carbohydrate is the nutrient in your food that takes around five hours (maximum) to raise your blood sugar level. After that, the sugar level in blood starts dropping, your brain signaling the pancreas to release the glucagon hormone. This hormone will signal the liver to convert stored glycogen to glucose and releases into the bloodstream. Thus, the blood-sugar level after five hours since you last had food is the indication of your liver’s glucose mechanism. The fasting blood sugar number indicates your liver’s glucose mechanism only. And it does not show anything about your body’s response to the food you ate.

To know how your body handles the food (mainly carbohydrate); you should test your blood sugar after one or two hours after start taking your meal.  After ingesting food, your blood sugar rises for about two hours and then returns to normal within the next two hours.
Thus, you should check your fasting that is before eating anything and two hours after start eating your meal.

When do you do BS testing?

Test your BS at different times, such as fasting, one hour after each meal, two hours after each meal, and at bedtime. It makes eight tests per day; fasting, three meals, two tests each (1 & 2-hours after food) equals six tests, and at bedtime. These tests help you to learn:

  1. How long after a meal, blood glucose is rising to its peak. 
  2. How fast it is returning to normal.
  3. You will see how carb foods such as bread, potato, pasta, etc. raise your BS reading.
  4. How certain low carb foods produce the least rise in your BS?

How often BS tests you need to do?

Leading diabetes institutions does not recommend SMBG for type2 diabetes if you are on lifestyle diabetes control or medications. Only those on insulin treatment can test twice daily.

However; diabetes type 2 requires to test their blood sugar two or more times, when newly diagnosed, changing medication, ingesting new-food, unstable BS, high blood sugar levels (fasting >130mg/dl, postprandial >180mg/dl), acute illness, pregnancy, on insulin therapy, severe illness, hypoglycemia risk, and if job warrants (such as pilots, critical jobs, etc.).

If your A1C is within your target range (A1C of less than 7%), you do A1C test twice a year. If it is not in your target range, you do A1C test four times a year.

Testing four times a day roughly requires $120 a month for test strips. If you are not affording to check BS frequently, then you can do block testing. It means-testing four or more times a day, only one day per week. Record what you eat, how active you are, what & when you have medication, quality of sleep, stress level. Etc.

If your type2 diabetes is in control, you do not need to test more frequently and could test once a week.  If your diabetes control is not as expected and try improving it, then you should check more often as needed.

Reasons for elevated fasting blood sugar: inadequate sleep, any form of pain, illness or infection, skipping your regular exercise, missed your previous medication night, too much of stress and or right before a menstrual period.

Reasons for elevated postprandial blood sugar:

  • overeating,
  • ingesting wrong food (more carbs or sugar),
  • forget to take medication (or need medication change),
  • any form of pain, illness or infection,
  • before a menstrual period,
  • taking steroids (prednisone or cortisone),
  • skipping exercise earlier in the day, and or
  • stressed out.

Low blood sugar BS testing

The blood sugar level of under 70mg/dL is hypoglycemia. It needs treatment by ingesting a quick source of a carb like three to four glucose tabs, half cup juice, half regular soda (six ounces), eight ounces nonfat milk, etc.  Waited for ten minutes, retest and makes sure it is over 80.  If BS remains below 80, then repeat the treatment and retest in 15 minutes until BS rises above 80. 

Type 2 diabetes who experience frequent hypoglycemia should not tighten their control. Also, those who have occasional non-symptomatic hypoglycemia should not follow tight blood sugar control.