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Page 18
THURSDAY, SEPTEMBER 22, 2016
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By Peter Galvin, MD
Ask
the
DOC
Diabetes Check
The American Diabetes Asso-
ciation (ADA) recommends that
all diabetics perform self-moni-
toring of their blood glucose lev-
els. Self-monitoring promotes
personal responsibility and
provides an opportunity for bet-
ter diabetic control. It has been
shown that diabetics whomoni-
tor their own glucose levels have
lower hemoglobin A1c levels (a
lab test used to evaluate diabetic
control) and have lower rates of
diabetic complications such as
eye and kidney disease. Diabet-
ic patients often ask how often
they should check their glucose
level. The answer usually is “it
depends.”
All Type I diabetics and Type II
diabetics on insulin should reg-
ularly check their blood sugar.
For these people the ADA rec-
ommends checking it at least
before meals and snacks, occa-
sionally after meals, at bedtime,
before exercise, whenever they
suspect their level might be low,
after treating a low level until
the level is normal and before
critical tasks like driving. Some
oral medications used to treat
Type II diabetes can cause low
blood sugar and diabetics on
these medications should also
check their levels often. These
medications are sulfonylureas
(glipizide, glimepiride and gly-
buride) and meglitinide (Pran-
din).
The ADA recommends the
following glucose goals for
non-pregnant diabetics: fast-
ing and pre-meal – 80 – 130;
two hours after a meal – less
than 180; bedtime – 100 – 150.
Of course everyone is differ-
ent and these levels are only a
guideline. For example geri-
atric patients prone to hypo-
glycemia (low glucose) may
be more harmed than bene-
fitted by intensive treatment
thus their goal levels should
be higher. Results should not
be viewed as “good” or ‘bad”
but rather should be used as a
tool to identify opportunities
for changes in treatment. That
is why keeping a log of levels is
important.
Deciding which monitor and
strips to use is often guided by
financial factors. Some insur-
ance plans only cover certain
meters and strips. Basic me-
ters are cheap, often about $15,
which is why themanufacturers
will send free meters to doctors
to give to their patients. They
make their money from the sale
of the strips, which can range
from $0.18 to almost $2 each
without coverage. Some me-
ters are more complex and can
calculate insulin dosages based
on diet and other information
uploaded by the patient. Some
meters can also transmit results
to smartphones using apps like
Accu-chek Connect Mobile
app. All meters should be pe-
riodically checked for accuracy
using a control solution.
A common complaint about
checking glucose levels is that
it hurts. Here are some recom-
mendations to reduce pain: use
a new lancet every time, choose
a lancet device with a depth
gauge and choose the lowest set-
ting that will draw blood, choose
smaller gauge lancets (28 to 33
gauge with the higher number
being thinner) and poke the side
of the finger rather than the mid-
dle (there are fewer nerve end-
ings on the side of our fingers).
If you are diabetic and are not
checking your levels talk to your
doctor about getting started.
For more information go to the
ADA website. For more informa-
tiononmeters trywww.diabetes-
forecast.org
Please direct questions and
comments to editor@rockaway-
times.com