For most people with diabetes, testing blood glucose is a basic component of life. These numbers can reflect whether the condition is being effectively controlled.
However, there are many questions about such a simple concept. How often should it be tested? At what time of day should it be tested? Patients will work closely with their doctors to find the answers that will keep them healthy.
Setting goals
You can set a glycated hemoglobin (HbA1c) level of 7% or lower, which corresponds to an average blood glucose level of 154 mg/dl. Your doctor will recommend an HbA1c test every 3 to 6 months.
When you need to get tested and what goal to set depends on the following factors.
- Personal preference;
- Duration of diabetes;
- whether pregnant;
- Age;
- Other health problems;
- Medications being taken;
- whether there are complications such as retinopathy or neurological disease;
- Whether you may experience hypoglycemia without any signs.
Time to test
Once you and your doctor have determined your blood glucose level goals and the best way to reach them (through diet, exercise, or medication), you can decide when you should test your blood glucose.
Fast-belly glucose (FBG) levels are tested in the morning before drinking or eating, which is the preferred testing time for many people. It is common to test again at bedtime.
But what about other times? Dr. Pamela Allweiss of the Centers for Disease Control and Prevention (CDC) says that testing after breakfast or 1 to 2 hours before lunch gives a more complete picture of overall blood glucose.
The American Diabetes Association (ADA) says that when pre-meal blood glucose levels are OK but not yet at the HbA1c target, testing immediately after a meal can provide more accurate information to your doctor.
Dr. David Goldstein, a professor at the University of Missouri School of Medicine, said, “Testing is very important, especially after a patient has used insulin or medications that may cause hypoglycemia.” Measuring blood glucose concentrations before and after meals is important to understand blood glucose patterns and how to respond to them.
This shift is a reflection of a shift from a “one-size-fits-all” mindset to a more individualized approach to treatment.
Why?
Why is that, Allweiss said, the old argument was that better control would lead to fewer complications. This worked for people who were healthy despite having diabetes. But then doctors discovered that tighter control of blood sugar may not be safe for those with diabetes who have other conditions such as heart disease.
Tracking changes
All these tests are meaningless if the results are not tracked. Many glucose meters can do this now. Patients can also keep track themselves. A complete lifestyle diary, including diet and exercise habits and how they feel at different times of the day, will also help a lot.
There is a lot to monitor and learn. Self-testing is an important part of it. One number doesn’t tell the whole story.
The number itself is just a number, Allweiss says: “What we want to see is a pattern.”
Of course, the steps to take after testing are simple: consult your doctor, find out what all those numbers mean, and figure out how to reach the blood sugar goals that are set.
“Diabetes requires a lot of knowledge. It’s not like taking a pill or seeing a doctor twice a year. Patients have to dive into it,” Goldstein said, “We have great tools now, we just need to teach patients how to use them. Patients have to know what to do – and then they have to do it down the road.”