Use of glucometers in diabetes (Dr Jothydev Kesavadev MD, FRCP )

Jothydev Kesavadev MD, FRCP
Chairman and Managing Director
Jothydev’s Diabetes Research Centers, Trivandrum, Kochi

Though India is second only to China with shockingly high prevalence of diabetes, hardly 0.1% of patients regularly use a glucometer to adjust dosages of medications and lifestyles accordingly.
 Scientific associations like American Diabetes Association and International Diabetes Federation consider Self Monitoring of Blood Glucose (SMBG) by patients at their own houses or workplaces as the goal for success in management of diabetes, especially when they are on insulin shots. Studies done in several parts of India have proven prevalence of diabetes to be extremely high even among the physicians. Untimely food habits, lack of sleep, lack of structured exercise regimen etc. contribute to the development  of risk factors of diabetes like abdominal obesity, hypertension, and dyslipidemia. 

         The diagnosis of diabetes is made when HbA1c  is equal to or more than 6.5%, fasting is more than 126 mg% or random blood sugar values at any time is more than or equal to 200mg%. Whichever is the scenario, a repeat test is essential. Management of glycemia is extremely crucial in the prevention of long term complications, both micro vascular and macro vascular.

     Conventionally, patients are used to visiting a laboratory and performing a fasting and post breakfast blood sugar once or twice a month. Over  the years, with the escalating incidence  of complications of diabetes, the cost of treating chronic kidney disease, foot ulcers or cardio vascular illness are also increasing.

Though glucometers are available in the market for several decades, the more accurate biosensor based technology has become popular only during the past 4 - 5 years. Most of the new generation branded glucometers provides sugar values as accurate as laboratory values. The whole blood or capillary glucose values though measured by the glucometers are calibrated so as to provide venous plasma glucose values. Unfortunately there are innumerable brands of glucometers and counterfeit   glucometer strips are also  available in the market. We should be careful to procure the original glucometer test strips and store it in a cool place, away from light and heat sources. Some of the glucometer strips come with an expiry of 3 months time from the date it is opened. In the case of glucometers where code has to be changed every time a new bottleof strips are used, this should be strictly followed or else the reading obtained would be totally wrong. Too much squeezing of the finger tip to obtain a tiny blood sample may also contribute to an erroneous reading.

   Glucometers are of immense use not only in diabetes but also in pre-diabetes. Measurements of blood sugars once in a while like fasting, 1.5 to 2 hours after a main meal i.e. a  heavy lunch or heavy dinner, will help subjects with pre-diabetes, to know the levels to which the sugars can go up and down which and also correlate this  with their marginally elevated HbA1c levels.

Frequent monitoring of blood glucose  values with the help of an  accurate glucometer in consultation with  the diabetologist , diabetes nurse educators, and dieticians will  largely  benefit the subject in designing and planning  the time and  duration of exercise , selecting  the right food and switching over from  one treatment regimen to other.

 It is a common complaint from patients that the glucometer value does not match with the laboratory values at a nearby lab and unfortunately patient does not believe the very high values obtained in their glucometers. It is the duty of the diabetes educators or nurses to train the subjects on right technique
of using glucometer and convince the patient that glucometer values are actually accurate and that frequent monitoring will gradually lower the very high basal and HbA1c values.

  Going back to the history of   glucometers, the doctors in 1960's   never believed that such a technology will help in the management of  diabetes. It was an Engineer by name Richard Bernstein who himself being a type 1 diabetes patient started using the Ames Reflectance Glucometer and adjusted the dosage of insulin .Though he tried to publish his findings in a medical journal it was not accepted. Years later, he joined a Medical School and ultimately became an Endocrinologist. So it was an engineer turned doctor, who proved the invaluable role of glucometers in the management of diabetes. 

Managing uncontrolled diabetes without self monitoring of glucose at houses is considered totally unscientific and will inevitably result in one or more complications of diabetes in the next couple of years. 

 Let us adhere to the International guidelines of SMBG on diabetes and adjust treatment accordingly at frequent intervals.

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