MONITORING OF DIABETES

Monitoring of diabetes is very important for good control and prevention of complications.

I. Regular checking of blood sugar and adjustment of insulin dose according to the blood sugar level ensures good control.

Methods of checking blood sugar level

There are a number of methods for checking blood sugar levels at home. The best available method is with a glucometer since it is most accurate. If it is not possible for you to get a glucometer, then visual strips can be used.
Urine sugar was used for monitoring blood sugar at home before other methods became available. This method is very inaccurate because sugar spills over into the urine only when it is above 160mg/dl. Absence of sugar in urine does not tell us if the blood sugar is 160 or 60mg/dl, so this method of testing is not recommended.

Newer methods of checking blood sugar level

Recently newer methods for checking blood sugar have become available in some countries. Glucowatch is one of them. It measures the blood sugar without a needle prick. It draws fluid from the subcutaneous tissue, which lies under the skin and measures the glucose level in it. The glucose in the subcutaneous fluid correlates well with the blood glucose level. It does not work very well with sweat; hence its use may be difficult in a tropical country like India. This device is not available in India.

Continuous glucose monitoring system (CGMS): This is a device, which provides continuous, automatic monitoring of glucose in the subcutaneous tissue. A tiny, sterile, flexible electrode is inserted just under the skin. The sensor measures glucose values every 10 seconds, up to 3 days. These readings can be downloaded on a computer. It is not possible to know your blood sugar level throughout the day with a glucometer. The CGMS records up to 288 glucose values automatically each day. Exercise, meal plan and insulin dose adjustments can be made on the basis of multiple readings obtained. This device is available in India for use by doctors.

   


II. Physical examination by your physician or diabetologist once in 3-4 months is very important. In younger children and adolescents it is important to check if growth and puberty are progressing normally. Adjustment of insulin doses, exercise and meal plans are also done during the visit.

III. Laboratory workup: This includes checking

a. Glycosylated hemoglobin:
Your diabetologist will ask you to check your glycosylated hemoglobin (HbA1C) once in 3-4 months. The sugar in blood gets attached to hemoglobin, which is a protein in the blood cells and forms a complex called HbA1C. This tells us the average blood glucose level of the person over the last 12 weeks and is not influenced by occasional highs. If HbA1C is kept as close to normal as possible, the risk of long-term complications will be lower.

IV. Routine screening for complications and diseases associated with diabetes should be done every year: These include certain blood tests, urine examination and eye examination.
 
AREAS FOR INJECTION
The above drawing show areas of the body that are considered best for insulin injection because they are away from joints, nerves and large blood vessels. The chart below can be used to record where you give your injections each day. Start by giving your injection in the areas labeled with the number 1. Then continue to the areas labeled 2, and so on.9 use the chart below to make additional copies when needed.
 
INJECTION RECORD
SITE
 
1
2
3
4
5
6
7
8
Right Arm
A
 
 
 
 
 
 
 
 
Right Abdomen
B
 
 
 
 
 
 
 
 
Right Thigh
C
 
 
 
 
 
 
 
 
Left Thigh
D
 
 
 
 
 
 
 
 
Left Abdomen
E
 
 
 
 
 
 
 
 
Left Arm
F
 
 
 
 
 
 
 
 
Left Buttock
G
 
 
 
 
 
 
 
 
Right Buttock
H
 
 
 
 
 
 
 
 
 
 
 
 
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