1.Importance of self-monitoring
Self-monitoring helps you effectively monitor the effect of treatment, adjust the treatment plan in time, adhere to monitoring, control blood glucose to meet the standard for a long time, and prevent or delay the occurrence and development of complications.
Monitoring should not only monitor blood glucose, including blood glucose spectrum at all points, glycated hemoglobin, but also risk factors, including: blood pressure, weight and waist circumference, blood lipid, foot, kidney, fundus, cardiovascular disease.
2.Monitoring program of blood glucose and comprehensive indexes
Blood glucose monitoring program: the time points for blood glucose monitoring include: fasting, before lunch, before dinner; after breakfast, after lunch, after dinner; and blood glucose before bedtime and at night; in addition, it is necessary to monitor at any time when there are symptoms of hypoglycemia, and it is also necessary to pay attention to monitoring blood glucose before and after strenuous exercise. The target values of blood sugar control are: fasting 3.9~7.2mmol/L; non-fasting ≤10.0mmol/L
In addition to blood glucose which can reflect the blood glucose level in the body, there is another important indicator, glycosylated hemoglobin, which can reflect the average blood glucose level for 2-3 months and is the “golden indicator” for evaluating blood glucose control. Blood sugar and hemoglobin combine to form glycated hemoglobin (HbA1C), which is an irreversible reaction and proportional to blood glucose concentration, and remains for about 120 days, so it can reflect the average level of blood glucose for 2-3 months. Glycosylated hemoglobin should be monitored every 3 months, and every 6 months after reaching the treatment target, and the control target level is less than 7%. Each 1% decrease in glycosylated hemoglobin can reduce diabetes-related mortality by 21%, total mortality by 14%, the incidence of myocardial infarction by 14%, and the incidence of stroke by 12%.
Risk factors are monitored and risk factors all include.
Blood pressure, diabetes and hypertension can be described as a deadly combination that can increase the incidence of complications such as heart, brain, kidney and retinopathy. Some studies show that 30-80% of diabetic patients have hypertension. Strict blood pressure control in diabetic patients can reduce the incidence of stroke by 44%, myocardial infarction by 21%, and microangiopathy by 29%. The goal of blood pressure control in diabetic patients is to fall below 130/80 mmHg. Patients with diabetes without combined hypertension should have their blood pressure checked once a month. Patients with combined hypertension should have their blood pressure measured every morning and evening, and after their blood pressure is stable and controlled, their blood pressure can be measured one day a week.
Body weight and waist circumference are also to be monitored. Body mass index (BMI) = weight (kg)/height (m)2, normal value 18.5-23.9kg/m2, the control target is less than <24kg/m2; waist circumference method can reflect the degree of central obesity, the control target of waist circumference is less than 2250px for men and less than 2125px for women.
Diabetic patients are also often combined with abnormal lipid metabolism, which can lead to increased heart, brain, kidney, retinopathy and mortality. Controlling lipids to normal values can reduce major cardiovascular events by 37% and the incidence of stroke by 48% in diabetic patients, showing the importance of lipid control. Patients with diabetes need to have their lipids checked at least once a year, and those treated with lipid-regulating drugs need to be tested more frequently, and every three months during pregnancy.
The diabetic foot is one of the most serious and most expensive chronic complications of diabetes to treat. The relative risk of lower extremity amputation is 40 times higher in diabetics compared to non-diabetics. Prevention and treatment of foot ulcers can significantly reduce the rate of amputation. Diabetic foot is difficult to treat, but prevention is very effective. Foot examination should be strengthened, and those with foot disease and risk factors should check the foot daily, especially between the toes, including whether the foot has deformities, calluses, ulcers, skin color changes; dorsal foot artery and posterior tibial artery pulsations, skin temperature, and whether there are sensory abnormalities. General patients should visit the hospital every three months for foot and related examinations.
Diabetic nephropathy is also an important complication that threatens the health of patients, while microalbuminuria is also a risk factor for cardiovascular disease and renal failure.
The control goals of renal function in diabetic patients are: control goals: urinary albumin/creatinine ratio: <2.5mg/mmol (22mg/g) in men and <3.5mg/mmol (31mg/g) in women. Urinary albumin excretion rate: <20μg/min (30mg/24 hours). Patients with diabetes mellitus should pay attention to the examination of renal function for early detection of abnormal renal function. Urine routine is checked at each follow-up visit. Test urine microalbumin and serum creatinine concentration annually. Check every three months during pregnancy.
Diabetic retinopathy is the main cause of blindness in diabetic patients. Retinopathy occurs in about 10% of diabetic patients 5-9 years after the onset of the disease; after 15 years of the disease, retinopathy occurs in about 50%. Diabetic patients should undergo fundus examination once a year and every three months during pregnancy.
Cardiovascular disease is a major health threat in diabetic patients. Once chest tightness, chest pain, crushing pain or heaviness in the precordial region occurs, it is important to be alert for cardiovascular events; many patients do not have typical symptoms of chest pain. Patients with diabetes should be evaluated for risk factors for cardiovascular pathology at least annually. The assessment includes: current or previous cardiovascular history; age; presence or absence of abdominal obesity; smoking; dyslipidemia; family history; urinary albumin excretion rate; atrial fibrillation; and electrocardiographic status at rest.
3, common monitoring misconceptions
Monitoring should be comprehensive monitoring, but also scientific monitoring. Common misconceptions of blood glucose monitoring include.
1. Monitoring only fasting blood glucose, not postprandial blood glucose: Most patients neglect the determination of postprandial blood glucose. In fact, postprandial blood glucose is as important as fasting blood glucose, or even more important. In the past, blood glucose testing mostly required fasting, but recent studies have confirmed that in the early stage of diabetes, postprandial blood glucose often rises first and fasting blood glucose rises later, so checking postprandial blood glucose can help in the early diagnosis of diabetes; secondly, compared with fasting blood glucose, postprandial blood glucose rises are more closely related to diabetic macrovascular complications, and strict control of postprandial high blood glucose can help prevent diabetic macrovascular complications. Therefore, for diabetic patients, not only fasting blood glucose but also postprandial blood glucose should be checked.
2.Monitoring only blood glucose but not glycated hemoglobin: Blood glucose reflects “instantaneous blood glucose”, which is the “point” blood glucose of the test time, while HbA1C reflects the average blood glucose of 2 to 3 months, which is the “surface” blood glucose. “HbA1C can reflect the “golden indicator” of blood sugar level and is an important basis for doctors to adjust the treatment plan. Therefore, diabetic patients should monitor both blood glucose and HbA1C.
3, only when you feel uncomfortable to measure blood glucose: monitoring blood glucose should be monitored regularly, just by feeling is not allowed, sometimes the blood glucose is already very high, but the body does not have any discomfort.
4.Fishing for three days and monitoring only when you want to get up: Only regular monitoring can detect the abnormal situation of blood glucose in time.
4.Self-monitoring tips
Some patients are reluctant to measure blood glucose because they are afraid of the pain when taking blood from their fingers, a tip to reduce the pain is to take blood from the side of the finger instead of the tip or the belly. Because the peripheral nerves on the side of the finger are less than those on the tip or belly of the finger, the pain will be less.
Some patients are worried about the money of test paper, which is more expensive, but it is not worth mentioning compared to the cost of hospitalization due to complications.
Commonly used steps for blood glucose testing: Preparation before testing: Prepare blood collection tools, blood glucose meter and test paper, then clean the blood collection site and hang your arm naturally for a moment, which helps to take enough blood at once. Try to take enough blood samples at one time during the test, and do not squeeze the blood collection site hard to avoid squeezing out the inter-tissue fluid and affecting the monitoring results. Take care not to press or move the test paper and blood glucose meter. Requirements after the test: pay attention to record the test results and time; pay attention to the removed test strips and needles discarded in the appropriate containers.
Precautions for the use of blood glucose meter: adjust the code of blood glucose meter before testing, mark the date of use for the first time using a bottle of test paper, rotate and select the test site, do not squeeze hard after piercing the skin, keep the blood glucose meter clean, remember not to clean the meter with water. Keep it in a dry and light-proof environment, it should be kept in a sealed original container, the cap should be tightened immediately after each test paper removal, the old test paper bottle should be discarded in time, do not use the old test paper bottle to store the disinfection cotton ball, so as to avoid confusion of the bottle cap and make the test paper damp, and pay attention to the expiration date of the test paper.
Precautions for blood pressure measurement: Before taking blood pressure, you should sit and rest quietly for at least 5 minutes, within 30 minutes, no smoking or coffee, empty your bladder, maintain the correct sitting position for blood pressure measurement: preferably in a reclining chair, bare upper arm, upper arm at the same level as the heart, record the date and time of each blood pressure measurement and all blood pressure readings, not just the average.