Diabetes Monitoring
A person with diabetes:
- Monitors both his/her own condition him/herself
- Is also monitored by a multidisciplinary team consisting of: -
- Hospital specialist (diabetes)
- GP
- Diabetic nurse specialist based at either the hospital or the GP surgery
- Ophthalmologist or Optometrist
- Podiatrist (for foot care)
- Dietician
- Renal (kidney) Specialist but only if problems in this area exist.
Personal Monitoring
Most people with diabetes, especially insulin dependent diabetics, regularly check their blood glucose. Young people especially, who give themselves 3 to 4 injections a day (before meals) are in the habit of checking their blood glucose, so that insulin dosage can be adjusted for tight control. (This regime applies to slightly more mature people as well). This is done by pricking the finger, the blood is dropped onto a reagent strip, which is “read” by a machine about the size of a pocket calculator and a digital display shows the reading. The reading is usually recorded in a book and sometimes on computer.
Blood Testing
This should be done regularly (and in reality, is usually done once or twice a day). Any episodes of "hypos"or hypoglycaemia should be also recorded. The frequency of the hypo’s depends on the stability of the diabetes.
This helps to build up a picture of the individual’s diabetic control. With regards to the blood glucose levels, either advice is given to the patient about adjusting treatment, or with experience, the patient will do it him/herself.
The Glycosylated Haemoglobin (HbA1C), which is a blood test (the blood may be taken at any time of the day) is conducted in a laboratory. The blood may be taken in the GP’s surgery or hospital outpatients department, and the results are usually available in a day or two.
It demonstrates blood sugar levels over the previous 6 weeks or so, and is a good indication of general control. It is ideal to aim for an HbA1c reading of 6.5 to 7.5 % or less (normal range being 4 - 6%) if possible.
Urine Testing
This is not favoured now as a way of monitoring blood glucose, as the level of sugar in the urine does not accurately reflect what is going on in the blood. It is not routinely done at home.
Urine testing for ketones, however, is helpful, if ketosis (diabetic ketoacidosis or DKA) is suspected in an un-well diabetic patient (and for diagnostic purposes in a non- diabetic patient).
Other Monitoring
The monitoring of diabetics by health care professionals should happen at regular intervals depending on the type of diabetes, age of patient, age of onset, presence of complications and the amount of ongoing education that the patient needs about his/her condition.
Young patients with diabetes need to be seen regularly at first, after diagnosis, while the patient learns to cope with the illness. Baseline blood pressure checks, *retinal photographs (ideally once per year) and checks for microalbuminuria (microscopic protein in the urine) are done, as well as monitoring of blood glucose results, and HbA1c etc. This should be done by the specialist team (which would hopefully include the Diabetes Specialist Nurse).
* Retinal photographs will demonstrate the presence of early haemorrhages, and micro-aneurysms. The presence of these would alert the Specialist team, control of the diabetes will be intensified, the eyes will be checked more frequently and if necessary the person will be referred to the Ophthalmologist for laser treatment.
