Monitoring Diabetes

Diabetes is a metabolic disorder in which the body is unable to adequately use or adequately produce insulin. This inability to use insulin, whether because of body resistance or decrease production, results in a high level of glucose in the blood stream. This excess sugar is the reason behind the long-term complications, such as loss of a eyesight, kidney damage, sexual dysfunction and nerve damage. By adequately monitoring glucose levels an individual who is diabetic can often decrease the number of complications and the severity of those complications.

Blood glucose monitoring happens in two different ways. In the first case, an individual should monitor their blood glucose levels at least daily, if not three times daily, at home using a glucometer. In the second case the endocrinologist will order a blood test every three to six months to monitor other blood indicators that give the physician an adequate reading of how well-controlled the individual\’s glucose levels have been.

Decades ago these methods of monitoring blood glucose were not available. In fact, history has recorded the use of \”urine testers\”, or individuals who tasted urine in order to determine whether or not sugar was spilling into the urine. (1) Today, manufacturers have produced technologically advanced monitors that are small, inconspicuous and often need no more than a drop of blood in order to get an accurate reading.

By monitoring blood sugar over the entire day the individual helps to reduce the numbers of peaks and valleys in the glucose readings, which also helps to decrease the long-term complications. Monitoring blood sugar also helps in individual to learn how food, activity levels, stress, medicine and insulin all play a role together in the control of blood glucose. Using this information the patient can stay healthy, prevent or delay complications and prevent infections.

This monitoring at home is done with a glucose meter or glucometer. Your insurance plan will indicate which model of glucometer they are willing to pay for. The individual should also check with their endocrinologist to see which one the physician recommends. Consider the different features and which are important to you. For instance, those who have poor eyesight may want to spend a little bit more money for a meter that reads in large print. Others may want a meter that will store results over several days.

The second way of monitoring blood glucose levels is called the hemoglobin A1C. test. This is a simple lab test, often drawn in the doctor’s office that shows the average amount of sugar that has been in the person\’s blood over the past three months. This is the best test a health care provider can use to determine if the blood sugar is under good control. (2)

Glucose in the blood stream can become attached to hemoglobin. This is the part of the red blood cell that carries oxygen. The process of sugar becoming attached to hemoglobin is called glycosylation. Once the sugar is attached it stays for the life of the red blood cell, which is approximately 120 days. Researchers have determined the ratio of sugar in the blood to the amount of glycosylated hemoglobin. This means that the higher the level of blood sugar, the more sugar attaches to red blood cells.

Using the hemoglobin A1c test physicians can determine how stable glucose levels have been in the past 120 days. Results on the blood work are given in percentages. The lower the percentage the better control the individual has maintained.

In a major study of individuals who suffer from diabetes, the Diabetes Control and Complications Trial, researchers found how important this test really is. This study indicated that by lowering the hemoglobin A1C percentage the individual can delay or completely prevent serious complications of blindness, kidney failure and nerve disease. The study also indicated that lowering the level by any amount would improve a person\’s chances of staying healthy longer. (3)

Most endocrinologist or physicians will order this test at least twice a year. If the person has not been in good control or has a new diagnosis or has recently undergone surgery the tests may be ordered more often. Any changes to the treatment plan, differences in exercise routines for changes in diet would also be an indication for a hemoglobin A1c blood test to be ordered more frequently.

An individual with diabetes should have a test results that is less than 7%. Those who keep their levels close to 7% have a much better chance of delaying or preventing long-term complications. Studies have shown that people whose levels remained at 8% or higher have an increased chance of long-term complications. Any individual whose test result is greater than 8% should have their treatment protocols changed and diet reevaluated.

(1) The Health Fitness Project: History of Diabetes
http://www.thehealthfitnessproject.com/special-populations/diabetes/

(2) American Diabetes Association: A1C
http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c/

(3) National Diabetes Information Clearinghouse: DCCT and EDIC: The Diabetes Control and Complications Trial and Follow up Study
http://diabetes.niddk.nih.gov/dm/pubs/control/