Self-Monitoring in Diabetes: When and How Much?

Abstract

Self-monitoring of blood glucose (SMBG) is an integral component of diabetes care for patients with type 1 diabetes mellitus (T1DM). It is an essential tool for the improvement of glycemic control and to increase patient empowerment and adherence to treatment. The standard recommended frequency of SMBG in T1DM is 3-4 times daily, even though many patients might require more frequent monitoring in special conditions. The frequency of testing should be agreed upon by the patients and their healthcare teams. As a general rule, more blood glucose tests are needed as the therapy becomes more intensive. People using insulin pump therapy should perform SMBG at least 4-6 times daily, and especially during establishment of pump therapy. To confirm hypoglycemia, patients must perform SMBG and repeat it every 15 min until euglycemia. Patients undergoing frequent asymptomatic hypoglycemia should perform SMBG more often. During intercurrent illness, patients need to monitor their blood glucose levels at least every 4 h, or every 2 h when blood glucose levels keep rising, to avoid diabetic ketoacidosis. With physical activity, patients should perform SMBG before, during, and after exercise. While driving, SMBG should be performed before leaving and at 2-hour intervals during long journeys. The issue of SMBG in women with T1DM deserves specific attention, especially during the menstrual period, preconception time, pregnancy (at least 7 tests/day), and breastfeeding.Between 1964 and 1967, a new method for measuring glucose, Dextrostix, was introduced. Based on finger puncture with a lancet or with an injection needle, these strips extemporaneously determined capillary blood glucose, and provided an alternative for the sticks that determined urinary glucose. The test was performed by putting a thick drop of blood on the stick, washing it under water for the elimination of other blood constituents, and then comparing it, after 1 min of reaction, with a color scale ranging from light yellow to darker colors, depending on the amount of glu-