Glucose Monitoring

Monitoring behavior is itself therapeutic because it warns of the risk of hypoglycemia or a shift to a hyperglycemic state caused by dietary indiscretion or a smoldering stress. Glu-cometers are now available that require less than 1 ^L of blood (taken up by capillary action). A sample may be taken from a fingertip, earlobe, forearm, or thigh, with the result available in 5 to 15 seconds. Arm or thigh values are derived from interstitial glucose concentration and may be approximately 15 minutes "out of phase" with blood values if the patient is not in a fasting steady state. Average monitored values over 14 to 30 days correlate with HbA1c values. Monitored glucose data are also the basis of formulating therapeutic targets. For a young girl with diabetes, the fasting target may be 150 mg/dL to avoid early-morning hypoglycemia. As she matures, the target becomes the current American Diabetes Association (ADA) goal of less than 120 mg/dL fasting and before meals. In elderly diabetic patients, glycemic targets again can be liberalized to preclude hypoglycemic risks.

Although costs of monitoring must be considered, frequent glucose monitoring usually indicates the patient is well motivated and is attempting to make the necessary adjustments that will improve their mean glucose value and impact favorably on the HbA1c. In an informed patient with stable type 2 diabetes, there is less evidence that daily is any more effective than weekly testing.

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