1. Home Blood Glucose Monitoring Why, When & How Julie Freeland Hilary Yule

2. A few questions… Why? When? How?

3. Why? Type 1 Diabetes Mellitus -Strongly recommended -Improve control -Special circumstances Type 2 Diabetes Mellitus -Patient choice -Individual -Inform – food and exercise -Increase motivation

4. Why? Lifestyle change Record and understand results To involve Diabetes Team Patient empowerment

5. Why? HbA1c 8% Lower HbA1c - improvement Reference DCCT 1993

6. When? Individual patient choice Treatment changes HbA1c ↑ Lifestyle change Optimal control FOR PATIENT Record and Understand results

7. When? HBGM (Home Blood Glucose Monitoring) Meter Strips TIMING Different times -Pre-meals -Fasting -Before bed -2am

8. How? Using an appropriate meter suitable for individual needs. Diabetes Team are here to help

9. Special Circumstances Type 1 Diabetes Mellitus During illness or Ketonuria Before/After moderate Physical Activity Before Driving (any distance) Psychological/Emotional Stress Hypoglycaemia, alcohol Pregnancy or Pre-pregnancy planning

10. Special Circumstances Type 1 Diabetes Mellitus After a change of insulin/regimen DAFNE Change in lifestyle – job/shift work

11. Special Circumstances Type 2 Diabetes Mellitus During illness, steroids Before/After moderate Physical Activity Psychological/Emotional Stress Hypoglycaemia Pregnancy or Pre-pregnancy planning

12. Target? Individual basis Aim 4-9 mmol/l Discuss with the team 17 and above check for ketones Illness

13. HbA1c Average Mean plasma blood glucose(mmol/l) 12%19.5 11%17.5 10%15.5 9%13.5 8%11.5 7%9.5 6%7.5 5%5.5

14. Adjusting treatment Diabetes Team to educate and follow up on an individual basis

15. Ketone Testing Urine ketostix Blood ketones

16. Thank You Any Questions?