hormonal and metabolic disorders
Diabetes Mellitus (DM)
Monitoring Diabetes Treatment
Monitoring blood glucose levels is an essential part of diabetes care. Routine blood glucose monitoring provides the information needed to make necessary adjustments in medications, diet, and exercise regimens. It is potentially harmful to wait until there are symptoms of low or high blood glucose levels to check blood glucose. Experts recommend that people keep their blood glucose levels Between 80 and 130 mg/dL (4.4 and 7.2 mmol/L) fasting (before meals) Less than 180 mg/dL (10.0 mmol/L) 2 hours after meals Hemoglobin A1C levels should be less than 7%. Some people use a continuous glucose monitor (CGM), an external device that is attached to the body and continuously records blood glucose levels. When this type of device is used, doctors use a different measurement to determine how well blood glucose levels are being controlled. They use a value called time in range. Time in range is the percentage of time over a specific period that the blood glucose level is at the person's goal level. The usual range is 70 to 180 mg/mL (3.9 to 9.9 mmol/L). Because aggressive treatment to reach these goals increases the risk that blood glucose might go too low ( Hypoglycemia ), these goals are adjusted for some people in whom hypoglycemia is particularly undesirable, such as older adults. Some other goals are keeping systolic blood pressure less than 140 mm Hg and diastolic blood pressure less than 90 mm Hg. For people with diabetes who have heart disease or are at high risk for heart disease, the blood pressure goal is less than 130/80 mm Hg. Many things cause blood glucose levels to change: Diet Exercise Stress Illness Medications Time of day The blood glucose levels may jump after people eat foods high in carbohydrates. Emotional stress, an infection, and many medications tend to increase blood glucose levels. Blood glucose levels increase in many people in the early morning hours because of the normal release of hormones (growth hormone andcortisol), a reaction called the dawn phenomenon. Blood glucose may shoot too high if the body releases certain hormones in response to low blood glucose levels (Somogyi effect). Exercise may cause the levels of glucose in the blood to fall low. Blood glucose levels can be measured easily at home or anywhere. Afingerstick glucose testis most often used to monitor blood glucose. Most blood glucose monitoring devices (glucose meters) use a drop of blood obtained by pricking the tip of the finger with a small lancet. The lancet holds a tiny needle that can be poked into the finger or placed in a spring-loaded device that easily and quickly pierces the skin. Most people find that the pricking causes only minimal discomfort. Then, a drop of blood is placed on a reagent strip. The strip contains chemicals that undergo changes depending on the glucose level. The glucose meter reads the changes in the test strip and reports the result on a digital display. Some devices allow the blood sample to be obtained from other sites, such as the palm, forearm, upper arm, thigh, or calf. Home glucose meters are smaller than a deck of cards. Continuous glucose monitoring(CGM) systems use a small glucose sensor placed under the skin. The sensor measures blood glucose levels every few minutes. There are two types of CGMs, with different purposes: Professional Personal Professional CGMs collect continuous blood glucose information over a period of time (72 hours to up to 14 days). Clinicians use this information to make treatment recommendations. Professional CGMs do not provide data to the person with diabetes. Personal CGMs are used by the person and provide real-time blood glucose data on a small portable monitor or on a connected smart phone. Alarms on the CGM system can be set to sound when blood glucose levels drop too low or climb too high, so the device can help people quickly identify worrisome changes in blood glucose. dosing without fingerstick glucose confirmation. There are also systems in which Insulin Replacement Therapy to either stop delivery of CGM systems are particularly helpful in certain circumstances, such as in people with type 1 diabetes who have frequent, rapid changes in blood glucose (particularly when the glucose levels sometimes go very low), which are difficult to identify with fingerstick testing. CGM systems allow people to measure the period of time that their blood glucose stays within a certain range, and doctors use this measurement to set goals for treatment and adjustinsulindose. Even in people who don't useinsulin, CGM systems can provide valuable information about how different foods and activities affect their blood sugar. People shouldkeep a recordof blood glucose levels and report them to their doctor or nurse, or bring their meter or CGM reader to visits, to help doctors and nurses provide advice in adjusting the dose ofinsulinor the oral antihyperglycemic medication. Many people can learn to adjust theinsulindose on their own as necessary. Some people who have mild or early type 2 diabetes that is well-controlled with one or two medications may be able to monitor their fingerstick glucose levels relatively infrequently. Doctors can monitor treatment using a blood test called hemoglobin A1C. When the blood glucose levels are high, changes occur in hemoglobin, the protein that carries oxygen in the blood. These changes are in direct proportion to the blood glucose levels over an extended period. The higher the hemoglobin A1C level, the higher the person's glucose levels have been. Thus, unlike the blood glucose measurement, which reveals the level at a particular moment, the hemoglobin A1C measurement demonstrates whether the blood glucose levels have been controlled over the previous few months. People with diabetes aim for a hemoglobin A1C level of less than 7%. Achieving this level is sometimes difficult, but the lower the hemoglobin A1C level, the less likely people are to have complications. Doctors may recommend a slightly higher or lower target for certain people depending on their particular health situation. However, levels above 9% show poor control, and levels above 12% show very poor control. Most doctors who specialize in diabetes care recommend that hemoglobin A1C be measured every 3 to 6 months. Fructosamine, an amino acid that has bonded with glucose, is also useful for measuring blood glucose control over a period of a few weeks and is generally used when hemoglobin A1C results are not reliable, such as in people who have Overview of Anemia caused by deficiency of iron, folate, or Although urine can also be tested for the presence of glucose, checking urine is not a good way to monitor or adjust treatment. Urine testing can be misleading because the amount of glucose in the urine may not reflect the current level of glucose in the blood. Blood glucose levels can get very low or reasonably high without any change in the glucose levels in the urine. 