Where we have been, where we need to be Glucose Monitoring Where we have been, where we need to be In 1500 B.C., high glucose was indentified by ants going to a persons urine In 400 B.C., physicians were tasting urine to diagnose diabetes “Water tasters” used to diagnose up until the 17th century 1776 - sugar actually identified in the urine by Matthew Dobson Early 1800s: first chemical tests to detect sugar in urine 1915 - Benedict's reagent is used as a test for glucose in urine - testing becomes more common. 1941- Clinitest tabs are available and you can boil urine and get a quantitative glucose value

Now Glucose Monitor Accuracy Is Good, Sample Size Is Small and Coding Is Not Necessary Fast Test Time – most 5 seconds or less     Small Blood Sample – 0.3- 0.7 microliters Alternate Site Testing - Decreases pain associated with testing   No Coding Needed - Accurate and precise tests

Diabetes “Report Card” Self-Monitoring of Blood Glucose Among Adults With Diabetes — United States, 1997–2006 Only 60% of Americans with diabetes measure their blood glucose levels! NHANES III – 2001 29% of patients using insulin never test or test just once/month 65% of patients on orals never test* 80% of patients not using drug therapy never test Harris MI; NHANES III. Frequency of blood glucose monitoring in relation to glycemic control in patients with type 2 diabetes. Diabetes Care. 2001;24:979-982. The Average Type 2 patient checks their glucose 0.6 times a day Centers for Disease Control and Prevention. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/mm5643a3.htm. Accessed January 25, 2008 3

Why people don’t monitor blood glucose levels? University of New Mexico Health Science Center survey* Top four reasons for not monitoring: Finger soreness (492) Pain (428) Inconvenience (347) Fear of needles (117) * N=1895 Could it be that the number one reason is that no one has told them why they should? Burge MR. Lack oCare, August 2001;24:1502-1503f compliance with home blood glucose monitoring predicts hospitalization in diabetes. Diabetes.

Why Monitor? Why Should We Monitor? There are many reasons Evaluate food choices Evaluate exercise Evaluate medication Check for hypoglycemia It all makes perfect sense to us but………. Do the patients care? Why Should We Monitor?

We need to give them reasons Would they drive without these? We need to show them that they do the same thing in everyday life with other things When do we look at these the most? When we are at 0 or at 80?

What about a checkbook? Do we look at the balance before and after we write a check?

How do we explain why? How do we explain why? Everyone gets feedback on what they do. Their check stub How far they run How many sit-ups Their bowling average Their 401k So why not their food choices or medication? How do we explain why?

Putting into action! Ask the patient to check before eating a meal. Ask them to write down what they ate. Have them check about 2 hours later. Have them record the difference in the readings. If the increase is greater than 30 mg/dl ask them to write down why they think it happened. Joslin Diabetes Center. Blood glucose monitoring, your tool for diabetes control. Available at: http://www.joslin.org/managing_your_diabetes_650.asp. Accessed March 2, 2009. 3American Diabetes Association. Getting started. Available at: http://www.diabetes.org/weightloss-and-exercise/exercise/getting-started.jsp. Accessed March 2, 2009