The goal of diabetes treatment is to control blood glucose, blood pressure, blood lipids, and weight as close to normal as possible to prevent complications and delay their development. Diabetes education, diet control, reasonable exercise, self-monitoring and medication are the five driving forces of scientific treatment of diabetes. As one of the five principles of diabetes treatment, diabetes monitoring, mainly blood glucose monitoring, is the most commonly used and reliable method to monitor the condition, and good blood glucose control requires moderate frequency of blood glucose monitoring. Due to the influence of age, condition and compliance, many diabetics tend to judge their condition according to their self-perception in the past, and it is difficult to insist on regular blood glucose monitoring in the hospital. Nowadays, since the use of blood glucose meters is becoming more and more widespread, self-monitoring of blood glucose (SBMG) can be performed at home, so as to better understand the condition and adjust the treatment in time.
I. Advantages and disadvantages of blood glucose monitoring
Advantages of blood glucose monitoring.
1.Testing blood glucose is not affected by the change of renal sugar threshold, which is more accurate than measuring urine sugar, and can reflect the immediate level of blood glucose of the body more accurately, and provide direct basis for the adjustment of treatment.
2. The blood glucose test can reflect not only high blood glucose, but also low blood glucose, thus it is more suitable for insulin injection patients to discover low blood glucose in time.
3, SBMG allows us to monitor blood glucose at any time, grasp the small changes in ourselves, adjust the rhythm of life and the type of diet at any time according to the blood glucose level, and understand the effect of various treatments in order to get rid of diabetes, strengthen the control of blood glucose up to the standard and avoid complications.
Disadvantages of blood glucose monitoring.
1.Blood collection is an invasive examination, causing pain.
2.Ketone bodies cannot be detected.
3. It cannot be used as a basis for diagnosing diabetes. The diagnosis of whether someone has diabetes must be based on venous blood glucose, and the diabetic patients who conduct self-monitoring also need to go to the hospital regularly to draw blood to check blood glucose, in order to understand whether the blood glucose meter is accurate.
Second, the choice of common blood glucose time
In general, the fasting or pre-meal blood glucose level is 4-6 mmol/L, and the blood glucose value 2 hours after meal should not exceed 7.8 mmol/L. Factors affecting blood glucose level usually include: diet, exercise, medication, emotion and stressful situations (disease, surgery, trauma, pregnancy, childbirth), etc. A 10-year study of the Diabetes Control Complications Trial (DCCT) showed that ideal glycemic control reduced ocular lesions by 76%, renal lesions by 50%, and neuropathy by 60%, and in patients who already had such complications, ideal glycemic control delayed the progression of more than half of the ocular and renal lesions. A good indicator of blood glucose control is to maintain blood glucose values throughout the day in as normal or acceptable a range as possible. Therefore, the time of blood glucose monitoring includes blood glucose at any time throughout the day and 24 hours, generally speaking, including fasting blood glucose, pre-meal blood glucose, 2-hour post-meal blood glucose, bedtime blood glucose, random blood glucose and, if necessary, blood glucose at 1 to 3 a.m., etc.
Fasting blood glucose
It refers to the blood glucose value measured before breakfast, which is at least 8 hours fasting without calorie intake. Generally, the blood is taken at 7~9 am in the morning under fasting condition, and the repeatability of fasting blood glucose is good, and it is a mandatory item for diabetes diagnosis. When measuring fasting blood glucose, it is important to note that the fasting time should not be too long or too short, otherwise it will affect the determination of the results, and in addition, no strenuous exercise should be performed. The normal value of fasting blood glucose is 3.9~5.6 mmol/L. It mainly reflects the blood glucose level in the basal state without dietary load, which is the main basis for diabetes diagnosis, and it can also better reflect the basal insulin level and liver glucose output of patients. In order to understand the basal function of the pancreas, i.e. the severity of the disease and the appropriateness of the dose of medication in the evening of the previous day, fasting blood glucose should be tested
Pre-meal glucose
It refers to the measurement of blood glucose before lunch and dinner, and is mainly used for monitoring the disease during treatment. The blood glucose measured before lunch and dinner cannot be called fasting blood glucose.
Postprandial blood glucose (generally refers to the blood glucose 2 hours after meal, which corresponds to the OGTT2hPG for diagnosing diabetes)
It refers to the blood glucose level after 2 hours from the first bite of meal. The measurement should be taken at the same time and dose as usual for medication, insulin injection and meal. Two-hour postprandial blood glucose is affected by various factors such as the type of food eaten, the speed of gastrointestinal motility, the amount of exercise after meals and the level of blood glucose before meals. The normal value of blood glucose two hours after meal is 4.4~7.8 mmol/L. This is an important indicator reflecting the reserve function of pancreatic β-cells, that is, the ability of food to stimulate β-cells to secrete insulin after eating. If the function is good, the surrounding tissues are sensitive to insulin and there is no insulin resistance, the two-hour postprandial glucose value should drop to 7.8
mmol/L or less. However, if the reserve function is good or even some diabetic patients secrete insulin higher than normal, but due to the surrounding tissues’ resistance to insulin, or although insulin resistance is not obvious, but the function of pancreatic β-cells has been poor, the blood glucose two hours after meal can be significantly increased.
Monitoring blood glucose two hours after meal can detect possible postprandial hyperglycemia. Many type 2 diabetics do not have high fasting blood glucose, but have high postprandial blood glucose. If only fasting blood glucose is checked, some patients will often be missed. Meanwhile, the 2-hour postprandial glucose can better reflect the appropriateness of eating and using hypoglycemic drugs, which is not fully reflected by fasting glucose. In addition, the 2-hour postprandial blood glucose test does not affect the normal taking of medication or injection, nor does it affect the normal eating, so it will not cause particularly large fluctuations in blood glucose.
Bedtime blood glucose
It generally refers to the blood glucose value at 9-10 p.m., which reflects the control ability of pancreatic beta cells on high blood glucose after eating dinner and is the basis for guiding the dose of medication or insulin injection at night. In order to understand the control of blood glucose before bedtime and whether additional meals are needed at night, bedtime blood glucose should be monitored.
Random blood glucose
It refers to the blood glucose check at any time of the day (including the above times). Normal people generally do not exceed 11.1mmol/L. If the patient has typical symptoms of diabetes (“three more and one less” symptoms) and the random blood glucose is ≥11.1mmol/L, diabetes can be diagnosed. Checking at any time when hypoglycemia or obvious hyperglycemia is suspected, can understand the body’s effect on blood sugar under special circumstances, such as eating more, eating less, eating special food, trying a new diet, before and after exercise, going out to a banquet, mood swings, drinking alcohol, exertion, illness, emotional changes, menstruation, etc. It is necessary to capture the moment of hypoglycemia in time (within about 10 minutes), and to measure blood sugar in time when hypoglycemia is suspected to occur.
For example, newly diagnosed glucose patients often need to monitor their blood sugar regularly for a period of time so as to guide the treatment, and should generally insist on measuring 4-7 times a day. When blood glucose control is relatively stable, monitor 2-4 times a month; for those whose blood glucose control is not up to standard, monitor fasting and postprandial blood glucose at least 4 times a week at different times. Try a new diet, before and after exercise, when traveling, adjust the insulin dose or frequency, increase the monitoring frequency when there are symptoms of hypoglycemia, and when pregnant or planning to be pregnant.
When measuring blood glucose, sugar lovers should not only measure finger blood glucose, but also glycated hemoglobin or glycated albumin, so as to reflect the average blood glucose level in the last three months or three weeks, which is more helpful for doctors to judge the condition. If necessary, 24-hour dynamic blood glucose measurement can be conducted.
Third, the choice of blood glucose meter
Regarding the purchase of blood glucose meter, it is necessary to be careful. At present, the common blood glucose meters on the market can be divided into two categories according to the glucose measurement technology: electrochemical method test and light reflection technology test. The former is the reaction between enzyme and glucose to produce electrons and then use the current counting facility to read the number of electrons and then convert it into glucose concentration readings. The latter is through the intermediate products of the reaction between enzyme and glucose (colored substances), using a detector to detect the intensity of the reflected light on the reflective surface of the test paper, the intensity of these reflected light, into the glucose concentration, more accurate.
In the purchase of 4 major elements should be mastered.
1, accuracy: should try to be similar to the test value of the same time venous blood sampling, not too much difference, otherwise there may be a delay in the tragedy of the disease.
This point is due to the progress of production technology in recent years, regardless of the accuracy of domestic and imported blood glucose meters are similar. To test the accuracy of blood glucose meter, you can measure your capillary blood glucose (fingertip blood) with blood glucose meter, and at the same time take venous blood to determine venous blood glucose with biochemical meter, the blood glucose results of the two methods should be close to each other, and the error should be less than 15%. Blood glucose test strips are the key factors affecting the accuracy of blood glucose meter, some blood glucose test strips are bottled, and the test strips must be used up within 3~4 months after the test strip bottle is opened, some blood glucose test strips are packed with single piece of aluminum foil, which is not easy to be damp and valid for up to one year.
2.Look at the service: We should understand the after-sales service of the blood glucose meter and whether the supply of test strips is in place to prevent the situation of “cooking without rice”.
3, look at the operation of the machine: for example, whether the use of blood collection needle is convenient, the amount of blood needed, the time of machine reading, the size and clarity of the display, the convenience of battery replacement or not, whether the machine is beautiful, how the size and so on.
4, look at the price: the general price of blood glucose meter between a few hundred dollars to thousands of dollars, some brands in the campaign will be cheaper, of course, in the purchase of blood glucose meter price is not the most important, the key is the above three points. In addition, the general blood glucose meter is self-funded, blood glucose test strips are disposable, for many families is also an additional burden, need to be a comprehensive measurement. The comprehensive comparison is still very cost-effective.
When you buy a blood glucose meter, the expensive one is not necessarily the best one; the best blood glucose meter is the one most suitable for your use. If you have the right blood glucose meter for you, you have laid the foundation for scientific monitoring of blood glucose.
There is nothing that sugar lovers hate more than the stinging pain of blood glucose monitoring fingers when blood is taken. We have all been dreaming of a painless testing device.
Fortunately, there are two non-invasive or minimally-invasive blood glucose monitoring systems in the world that will soon be used in the clinic. One is the glucose watch made by cygnus; the other is the continuous glucose monitoring system made by minimed. Both detect the glucose concentration in the subcutaneous tissues and do not differ much from the comparison of blood glucose levels.