Monitoring in Type 2 Diabetes Senga Hunter Community Diabetes Specialist Nurse

Learning Outcomes Understand why blood monitoring is necessary Understand the blood tests for monitoring diabetes Understand glycaemic targets and tests performed Understand good practice in relation to blood glucose monitoring / testing

Type 2 Diabetes Type 2 diabetes occurs mainly in people aged over 40 The cornerstone of treatment is diet, weight control and physical activity If BGL’s remains high despite these measures, then oral glucose lowering agents are advised Insulin and GLP-1 injections are being prescribed more to patients living with type 2 diabetes Other treatments include: reducing blood pressure , high cholesterol levels and other measures to reduce the risk of complications

Q. Why do we need to monitor?

Identifies high and low blood glucose levels Assess the effectiveness of treatment Helps prevent long term diabetes complications Empowerment and self management

Ways to monitor HbA1c Blood Glucose Monitoring Urine Testing use of self monitoring of urine glucose is not recommended for routine clinical practice crude measure, not as accurate as BGM, BGL needs to >10mmol/L

HbA1c Glycosylated Haemoglobin Glycaemic target 48-58mmol/mol Q. Why is there a target? Q. How often should HbA1c be check? Q. Who should check?

How often & by whom? Annually Commonly done every 3-6 months GP, Practice Nurse, Diabetes specialists

Blood Glucose Monitoring Monitors day to day levels ‘Snap-shot’ Wide range of Blood Glucose Meters Diabetes UK Update guide Q. Who should test?

Who should test? NO  Some patients living with Type 2 diabetes who are diet or tablet controlled & meeting HbA1c target YES Long Term Use Patients living with Type 1 Patients living with Type 2 treated with insulin who should be using BGM to guide their insulin doses, and manage symptoms of hypoglycaemia People with Type 2 treated with sulphonylureas who drive and need to monitor blood glucose before or during driving Short Term Use – Patient scenarios treated with sulphonylureas who have had symptoms of hypoglycaemia or are at risk of hypoglycaemia commencing glucocorticoid treatment pancreatic surgery and/or pancreatitis during intercurrent illness e.g. following surgery, acute illness, pregnancy or gestational diabetes someone wishes to gain insight into their diabetes, and how blood glucose varies with dietary modification and exercise

How often? As often as necessary -depending on the individual patient and on insulin/ treatment regimen Example: With administration of insulin - before meals and before bed if at risk of hypoglycaemia, With administration of oral glucose lowering agents – before meals at varying times, also occasionally post prandial Increase at times of change i.e.: illness, exercise, adjustments to treatments

Glycaemic Targets Between 4 and 7mmols/L is ideal for most people 4 or below is hypoglycaemia 17 or above is hyperglycaemia Important to know the symptoms and action to take Target levels individualised for different patients depending on age, lifestyle, blood glucose levels target range should be agreed Seek advice - repeated episodes hypoglycaemia or recurrent hyperglycaemia

Good practice recommendations Health care professionals issuing blood glucose meters should provide clear guidance regarding, -blood glucose targets, interpretation of results, frequency & timing of testing -function of the meter including advice on error codes, BGM manual, registration of meter -meter company- monitoring diaries, technical support & assistance -test technique- hand washing, correct letting technique, sharps disposal, care of meter & test strips, temperature control -Quality Control Testing

In summary Refer to Diabetes UK for further information HbA1c -“Big picture”- provides an indication of overall diabetes control Blood Glucose Test is a “snap shot” of day to day blood glucose levels -frequency of testing should be individualised to the patient -correct technique & care of meter essential for accuracy & validity Urine testing – not recommended for routine clinical practice crude measure, not as accurate as BGM, BGL needs to >10mmol/L Refer to Diabetes UK for further information