3.3.0.0 For Pa­tients on In­ten­sive In­sulin Reg­i­mens

SMBG or CGM is es­pe­cial­ly im­por­tant for in­sulin-‍treat­ed pa­tients to mon­i­tor for and pre­vent hy­po­glycemia and hy­per­glycemia. Most pa­tients using in­ten­sive in­sulin reg­i­mens (MDI or in­sulin pump ther­a­py) should as­sess glu­cose lev­els using SMBG or a CGM 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. For many pa­tients using SMBG, this will re­quire test­ing up to 6–10 times daily, al­though in­di­vid­u­al needs may vary. A database study of al­most 27,000 chil­dren and ado­les­cents with type 1 di­a­betes showed that, after ad­justment for mul­ti­ple con­founders, in­creased daily fre­quen­cy of SMBG was significant­ly as­so­ci­at­ed with lower A1C (–0.2% per ad­di­tion­al test per day) and with fewer acute com­pli­ca­tions (46).