1. Monitoring in Type 2 Diabetes
Senga Hunter
Community Diabetes Specialist Nurse

2. 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

3. 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

4. Q. Why do we need to monitor?

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

6. 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

7. 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?

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

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

10. 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

11. 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

12. 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

13. 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

14. 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