3.0.0.0 SELF-‍MON­I­TOR­ING OF BLOOD GLU­COSE

3.1.0.0 In­tro­duc­tion

Rec­om­men­da­tions

7.6 Most pa­tients using in­ten­sive in­sulin reg­i­mens (mul­ti­ple daily in­jec­tions or in­sulin pump ther­a­py) should as­sess glu­cose lev­els using self-‍mon­i­tor­ing of blood glu­cose (or con­tin­u­ous glu­cose mon­i­tor­ing) prior to meals and snacks, at bed­time, oc­ca­sion­al­ly post­pran­di­al­ly, prior to ex­er­cise, when they sus­pect low blood glu­cose, after treat­ing low blood glu­cose until they are nor­mo­glycemic, and prior to crit­i­cal tasks such as driv­ing. B

7.7 When pre­scribed as part of a broad ed­u­ca­tional pro­gram, self-‍mon­i­tor­ing of blood glu­cose may help to guide treat­ment de­ci­sions and/‍or self-man­agement for pa­tients tak­ing less fre­quent in­sulin in­jec­tions. B

7.8 When pre­scrib­ing self-‍mon­i­tor­ing of blood glu­cose, en­sure that pa­tients re­ceive on­go­ing in­struc­tion and reg­u­lar eval­u­a­tion of tech­nique, re­sults, and their abil­i­ty to use data from self-‍mon­i­tor­ing of blood glu­cose to ad­just ther­a­py. Sim­i­lar­ly, con­tin­u­ous glu­cose mon­i­tor­ing use re­quires ro­bust and on­go­ing di­a­betes ed­u­ca­tion, train­ing, and sup­port. E

Major clin­i­cal tri­als of in­sulin-‍treat­ed pa­tients have in­cluded self-‍mon­i­tor­ing of blood glu­cose (SMBG) as part of mul­ti­fac­to­ri­al in­ter­ven­tions to demon­strate the benefit of in­ten­sive glycemic con­trol on di­a­betes com­pli­ca­tions (40). SMBG is thus an in­te­gral com­po­nent of ef­fective ther­a­py of pa­tients tak­ing in­sulin. In re­cent years, con­tin­u­ous glu­cose mon­i­tor­ing (CGM) has emerged as a com­ple­men­tary method for the as­sess­ment of glu­cose lev­els (dis­cussed below). Glu­cose mon­i­tor­ing al­lows pa­tients to eval­u­ate their in­di­vid­u­al re­sponse to ther­a­py and as­sess whether glycemic tar­gets are being safe­ly achieved. In­te­grat­ing re­sults into di­a­betes man­agement can be a use­ful tool for guid­ing med­i­cal nu­tri­tion ther­a­py and phys­i­cal ac­tiv­i­ty, pre­vent­ing hy­po­glycemia, and ad­justing med­i­ca­tions (par­tic­u­larly pran­di­al in­sulin doses). The pa­tient’s specific needs and goals should dic­tate SMBG fre­quen­cy and tim­ing or the con­sid­er­a­tion of CGM use.