Modern methods of self-monitoring of blood glucose in patients with diabetes mellitus

One of the most important conditions for the successful treatment of diabetes is self-control. Regular and competent self-monitoring allows you to maintain a normal or close to normal blood glucose level. This is the most reliable means of preventing the development of diabetic complications! The ability to manage your diabetes needs to be learned from the very beginning of the disease. From the very first day of treatment, patients learn how to inject insulin and determine their blood glucose levels. However, this knowledge is far from sufficient. It is necessary to pass training in a school for patients with diabetes, and after some time, when some experience has accumulated, to pass it again. Repeated training contributes to the fact that the same information is perceived in a different way, from the height of the accumulated experience.

What is self-control?

• Conducting regular blood sugar tests and, most importantly, the ability to analyze the results and apply the necessary measures.
• Mandatory accounting of the regime and features of nutrition and physical activity.

The ability to independently change the dose of insulin, depending on the blood sugar level and changing conditions of the day.

In order to lead the same lifestyle that was habitual before the disease, it is necessary for the patient and his family members to learn the basic rules of self-control.

If you can independently detect changes in your condition, regularly determining the level of blood glucose, urine, acetone in the urine, in the blood, you can achieve excellent results. Together with the doctor and parents, you can make sure that the disturbed metabolism is normalized, thereby preventing various complications that can develop due to insufficient control.

Why is blood glucose monitoring necessary?

If you know the blood glucose level at any given time, you can solve several questions at once:

• Is the dose of insulin that the patient has injected sufficient?
• How much insulin is currently administered depending on the glucose level (normal blood glucose, low (hypoglycemia), high (hyperglycemia)?
• Should I change my insulin dose or diet before exercise?
• How to change the dose of insulin during the disease?

What is necessary for self-control?

It is always possible to conduct a quick blood test in any conditions without the participation of medical personnel on their own.

In recent years, among the means of self-monitoring, the leading positions are firmly occupied by glucose meters — portable devices designed specifically for monitoring blood sugar levels at home.

To date, patients have a large selection of blood glucose meters, which are produced by various companies. All of them are quite easy to handle, provide high accuracy of results and allow you to get the result in a short time. Therefore, the main task is to choose the most appropriate blood glucose meter for each individual patient.

These devices have different appearance, shape, weight and color. Glucose meters differ in the calibration of the device (plasma or whole blood), the size of the blood drop required to obtain the analysis, the speed of obtaining the result, the size of the memory for the tests already performed, the presence of additional functions (communication with the computer, calculating the average value of glycemia, highlighting the test area and the display of the device), and, of course, the cost of the device and test strips.

The small size of modern blood glucose meters and the minimum time to determine the blood sugar level (5-10 seconds) allow you to determine the blood sugar level not only at home, but also in any other place — at a party, in a cafe, on a walk. At any time, you can quickly and with minimal effort independently assess the amount of blood sugar at a particular time.

To date, all manufactured blood glucose meters have sufficient accuracy. However, it should be remembered that the accuracy of the results depends on the type of test strips, storage conditions and shelf life, and skill and skill. It is not necessary to compare the indicators of your blood glucose meter with a friend's blood glucose meter or with a polyclinic device. In order to find out how accurate your device is, it is necessary to examine the sugar level from one drop of blood by two methods — on a glucose meter and on a biochemical stationary analyzer.

The blood glucose meter is considered accurate if the deviation of the obtained result is within 20%.

When performing a blood sugar test, it is necessary to obtain a blood sample in the form of a drop for analysis. To take blood, it is recommended to use special automatic devices for piercing the skin of the finger-lancets, acting on the basis of a spring mechanism. The injection when using these devices is almost painless, the skin injury is less, the wound heals faster.

How often do I need to monitor my blood glucose levels?

When conducting self-monitoring of blood glucose, it is necessary to take into account many factors:

• non-constant physical and school load;
• frequent changes in appetite (especially in young children);
• diet disorders;
• various diseases.

Any of these factors can cause an increase or decrease in blood glucose levels. To find out about this, you can only determine the level of glucose on the glucose meter, therefore, the level of glycemia must be determined several times a day.

When determining the glucose level, you need to remember about very common mistakes that can significantly affect the result. These include:

• sugar residue on your fingers (for example, from fruit);
• leftover hand cream;
• residues of disinfectants or alcohol in a drop of blood;
• too much pressure on the finger to extract a drop of blood;
• insufficient amount of blood on the test strip;
• invalid code number;
• test strip with an expired expiration date, a wet strip or a strip that has been lying for a long time after opening;
• the ambient temperature is too high or too low.

Optimal for most patients who are on intensive insulin therapy is daily self-monitoring, including 4 studies of glycemia, three of which are carried out before the main meals and the fourth-before bedtime.

However, there are situations when blood glucose levels should be monitored much more often:

• Days of poor health (especially if there is vomiting or diarrhea) - every 2-3 hours.
• Unusual physical activity or a change in the usual rhythm of life — before and after activity.
• Change in the amount and time of meals-before and after meals.
• Symptoms of high or low blood glucose-at the time of the onset of symptoms.
• Air travel across time zones.
• Suspicion of nocturnal hypoglycemia — in the night hours from 02.00 to 04.00. The following symptoms may indicate that there may have been hypoglycemia during the night.
• High glucose levels in the morning with good indicators at the same time on other days.
• Headache.
• Feeling overwhelmed in the morning.

In the last few years, ambulatory daily blood glucose monitoring devices have been used for self-monitoring of glucose. The device is as easy to use as a regular blood glucose meter, but unlike it, you can constantly determine blood sugar, any number of times a day, and a curve (graph) of blood glucose will always be available for a day or several days.

Chief freelance specialist endocrinologist,
health departments of the Lipetsk region,
Gorbunova Natalia Petrovna