Jothydev Kesavadev MD, FRCP
Chairman and Managing Director
Jothydev’s Diabetes Research Centers, Trivandrum, Kochi
www.jothydev.net
[email protected]
Though India
is second only to China
with shockingly high prevalence of diabetes, hardly 0.1% of patients regularly
use a glucometer to adjust dosages of medications and lifestyles accordingly.
Scientific associations like American
Diabetes Association and International Diabetes Federation consider Self
Monitoring of Blood Glucose (SMBG) by patients at their own houses or
workplaces as the goal for success in management of diabetes, especially when
they are on insulin shots. Studies done in several parts of India have
proven prevalence of diabetes to be extremely high even among the physicians.
Untimely food habits, lack of sleep, lack of structured exercise regimen etc. contribute
to the development of risk factors of diabetes like abdominal obesity,
hypertension, and dyslipidemia.
The diagnosis of diabetes
is made when HbA1c is equal to or more than 6.5%, fasting is more than
126 mg% or random blood sugar values at any time is more than or equal to
200mg%. Whichever is the scenario, a repeat test is essential. Management of
glycemia is extremely crucial in the prevention of long term complications,
both micro vascular and macro vascular.
Conventionally, patients are used to
visiting a laboratory and performing a fasting and post breakfast blood sugar
once or twice a month. Over the years, with the escalating incidence
of complications of diabetes, the cost of treating chronic kidney
disease, foot ulcers or cardio vascular illness are also increasing.
Though glucometers are available in the market for several
decades, the more accurate biosensor based technology has become popular only
during the past 4 - 5 years. Most of the new generation branded glucometers
provides sugar values as accurate as laboratory values. The whole blood or
capillary glucose values though measured by the glucometers are calibrated so
as to provide venous plasma glucose values. Unfortunately there are innumerable
brands of glucometers and counterfeit glucometer strips are also available in the market. We should be careful
to procure the original glucometer test strips and store it in a cool place,
away from light and heat sources. Some of the glucometer strips come with an
expiry of 3 months time from the date it is opened. In the case of glucometers
where code has to be changed every time a new bottleof strips are used, this
should be strictly followed or else the reading obtained would be totally
wrong. Too much squeezing of the finger tip to obtain a tiny blood sample may
also contribute to an erroneous reading.
Glucometers are of immense use not only in
diabetes but also in pre-diabetes. Measurements of blood sugars once in a while
like fasting, 1.5 to 2 hours after a main meal i.e. a heavy lunch or
heavy dinner, will help subjects with pre-diabetes, to know the levels to which
the sugars can go up and down which and also correlate this with their
marginally elevated HbA1c levels.
Frequent monitoring of blood glucose values with the
help of an accurate glucometer in consultation with the
diabetologist , diabetes nurse educators, and dieticians will largely
benefit the subject in designing and planning the time and
duration of exercise , selecting the right food and switching over
from one treatment regimen to other.
It is a common complaint from patients that the
glucometer value does not match with the laboratory values at a nearby lab and
unfortunately patient does not believe the very high values obtained in their
glucometers. It is the duty of the diabetes educators or nurses to train the
subjects on right technique
of using glucometer and convince the patient that glucometer values are
actually accurate and that frequent monitoring will gradually lower the very
high basal and HbA1c values.
Going back to the history of glucometers, the doctors in 1960's never believed that such a technology
will help in the management of diabetes. It was an Engineer by name
Richard Bernstein who himself being a type 1 diabetes patient started using
the Ames Reflectance Glucometer and adjusted the dosage of insulin .Though
he tried to publish his findings in a medical journal it was not accepted.
Years later, he joined a Medical
School and ultimately
became an Endocrinologist. So it was an engineer turned doctor, who proved the
invaluable role of glucometers in the management of diabetes.
Managing uncontrolled diabetes without self monitoring of
glucose at houses is considered totally unscientific and will inevitably result
in one or more complications of diabetes in the next couple of years.
Let us adhere to the International guidelines of SMBG
on diabetes and adjust treatment accordingly at frequent intervals.
