1. 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
sugar actually identified in the urine by Matthew Dobson
Early 1800s: first chemical tests to detect sugar in urine
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

2. 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 – microliters
Alternate Site Testing - Decreases pain associated with testing
No Coding Needed - Accurate and precise tests

3. 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:
The Average Type 2 patient checks their
glucose 0.6 times a day
Centers for Disease Control and Prevention. Available at:
Accessed January 25, 2008 3

4. 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: f compliance with home blood glucose monitoring predicts hospitalization in diabetes. Diabetes.

5. 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?

6. 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?

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

8. 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?

9. 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: Accessed March 2, American Diabetes Association. Getting started. Available at: Accessed March 2, 2009