Blood Glucose Monitoring Liz Gregory / Sue Russell October 2013

Blood glucose monitoring This presentation will:  Discuss the essential areas where SMBG is medically and legally indicated  Where SMBG can form a helpful factor for individuals to be empowered to self manage more effectively  Then Sue will present how we can significantly reduce costs of SBGM  We will end with an “exclusive” direct from Barcelona

What is good BG control? Capillary blood tests – DAFNE targets  7.5 mmol/L before breakfast  mmol/L before lunch  6.5 – 8.0 mmol/L before bed HbA1c (45-55 mmol/mol) Levels below 43 predispose to severe hypo and developing hypo unawareness

Purpose of self blood glucose monitoring  To assess response to medication/ diet / exercise  To feel well/avoid minor infections from hyperglycaemia  To prevent short and long term problems of diabetes by prompt detection & treatment of hypo- & hyperglycemia/ sick day management  Comply with DVLA if on insulin / SU’s  For women planning a pregnancy to ensure healthy baby  Max OHA /Pre insulin - aid decision making  At Diagnosis – if Type1/unsure of diagnosis  To safely adjust insulin  Patient safety if Hypo unaware

Can HbA1c replace SMBG ? No  Because it is largely an average  It can miss very low /hypo/hyper  Does’nt enable you to understand which medication /timing needs adjusting  False information in renal, anaemia /haemoglobinopathies  False high or low or average HbA1c  Detect analytical errors at path lab

Who should self test ?  All Type 1 patients  Gestational diabetes  Type 2 insulin treated  Type 2 -SU therapy if car driver/medication changes  Glp-1 plus SU and/or insulin  Illness – if on Metformin /SU / insulin short term  Patients on maximum OHA’s and above target  Pts with diabetes started on high dose steroids  Pre insulin start – max OHA’s  New diagnosis where type of diabetes is unclear  Periods of sickness

How to reduce costs ? Appropriate Type 2  Meters with test strips costing under £10 per 50  Reduce frequency of testing - Over to Sue

Sue

“Exclusive “  Abbott are launching an innovative new technology in BGM end of 2014  A sensor inserted under skin – changed every two weeks.  Hand set device - can read the blood glucose levels  Truly revolutionary in trials

Type 2 and Insulin  Type 2 patients should be managed on Human insulin if possible (there are some exceptions as per your hand out )  We cannot manage a whole scale switch over but if Practices have GP’s or P/N’s who initiate insulin, they could easily switch patients – all that is necessary is advice on timing and reduction at initial changeover  Local Hospital and HCT will be actively changing /starting appropriate patients where possible

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