Studies in various parts of the country have indicated that the single blood-glucose measurement, done in the physician’s office every few weeks or months, is still the most common method of diabetes management in the United States. However, other studies have demonstrated the futility of this type of management, and more and more people are being treated by physicians who weigh the results of self testing of blood glucose (SMBG) and glycosylated hemoglobin of some form (such as HgAic or HgAi), rather than having a single blood-glucose measurement done.
The philosophy of obtaining a fasting or postmeal blood-glucose measurement in the doctor’s office is that blood glucose is relatively stable and that the measurement obtained thus reflects the level over the past few weeks and predicts the level for the next few weeks. Nothing could be further from the truth. We reviewed a patient’s chart recently and found the following office blood sugars at 3-month intervals: 217, 67, 197, 46, and 125 mg/dl.
If management is based on these measurements, the medicine would have been increased at blood sugars of 217 and 197, decreased at 67 and 46, and kept the same at 125. In actual fact, in comparison with the HgA1c the blood-sugar (glucose) averages obtained through self testing were about the same for each visit, indicating that there was no need for any change in the diabetes medication. Blood sugar is constantly changing, so a blood-sugar test in the doctor’s office measures the blood sugar only for that moment in time.
The frequency of self-blood testing suggested that testing is different for different clinics. Researchers have shown that the more testing done (and responded to), the better the control and the fewer the complications. Lower blood-glucose levels are found before each meal and at bedtime. Higher blood sugars are found after meals. One hour after a meal, the blood sugar would be higher than 2 hours after a meal. If a person could remember to test for blood-sugar levels on arising and 2 hours after a meal, more information for control would be obtained than if the more easily remembered pre meal and bedtime blood-sugar tests are used.
Again, physician preference may guide the person into testing one way or another that is, testing the fasting blood sugar and 2 hours after each meal, or before meals and at bedtime. If the physician does not ask you to do blood-sugar tests at home but does them in the office only, be suspicious that you are not receiving the best of care as recommended by the American Diabetes Association and the American Association of Diabetes Educators.