Self-Monitoring of Blood Glucose (SMBG)

 

 

What does (SMBG) stand for?

 This abbreviation stands for self-monitoring of blood glucose, which means enabling the diabetic patient to track his own blood sugar level through measuring it with a blood glucose meter device then utilize these results in modifying his lifestyle or treatment protocol. It is also suggested that regular checking of SMBG enhances the overall health condition.

 Self-monitoring of blood glucose (SMBG)  is one of the primary factors involved in the overall process of diabetes management.  The patient’s medical care attendants have to guide him towards selecting the glucose meter that is most appropriate for his condition which is the key to obtain accurate results. Checking SMBG regularly also contributes to the enhancement of glycemic control.

 

What is the significance of SMBG for diabetes management?

  1. Educating and training patients on how to identify hypoglycemia or hyperglycemia
  2. Raising patients’ awareness of the influence of lifestyle and medication on glycemic control
  3. Enabling diabetic patients /their families to make good decisions concerning inter alia, exercising, dietary pattern, insulin…, on a regular basis to boost the treatment process 
  4. A number of controlled trials indicated the importance of self-management blood glucose for type 1 diabetes

 

What can be considered a normal blood glucose range?

People with diabetes always seek to maintain their blood sugar within the normal range to avoid complications like hypoglycemia or hyperglycemia, as well as, diabetes kidney disease and retinopathy in the long run. SMBG helps these patients achieve their target i.e. keeping the preprandial blood glucose within the range of  70–130 mg/dl and postprandial blood glucose below 180 mg/dl.

 

The relation between glycemic control and microvascular/macrovascular diseases:

Self-monitoring of blood glucose is an effective player in the treatment of type 2 diabetes. Several clinical trials indicated- based on the results of A1C tests, that glycemic control was found to lower the chances of acute microvascular and macrovascular complications a diabetic patient can face. Moreover, it was also established that the raised blood glucose level (hyperglycemia) which occurs after eating food may also lead to microvascular/macrovascular complications, hence can put the patient at the risk of cardiovascular diseases. Thus type2 diabetes patients should try hard to avoid such complications

Self-monitoring of blood glucose (SMBG) is still considered the preferred technique for the majority of diabetic patients. According to the statement of the Centers for Disease Control and Prevention in 2015, 62% of patients self -monitor their blood glucose level a minimum of once daily. SMBG is also an integral part of the A1C measurement procedure.

 

The difference between self-monitoring of blood glucose (SMBG) and A1C monitoring?

SMBG allows the patient to differentiate between the factors influencing blood glucose levels like exercising, food and medicines, as it gives him immediate details about fasting, pre-prandial, and postprandial blood glucose levels. For optimal results, SMBG should be included in the diabetes self- management routine on individualized basis, this is where the diabetes caregiver’s role becomes very important as he ascertains that the patient is fully aware of the benefits and usage of the SMBG approach, more importantly he has to confirm that the patient can assess the information he gets from SMBG and knows how to use them to enhance his blood glucose levels.

 

The role of diabetes caregiver in brief:

  • Helping the diabetic patient choosing the SMBG device that best suits him
  • Conducting a full assessment of the patient’s blood glucose level and use the results effectively
  • Teaching patients how to use the glucose meter device 
  • Making decisions about SMBG timing
  • Using measurement results to make a plan for enhancing diabetes self-management

 

Is SMBG an effective tool in glycemic control?

A broad spectrum of studies have indicated that SMBG contributed to the enhancement of the overall health of patients with type 1 diabetes, it was noted that the more SMBG was conducted the lower HbA1c was recorded in a group of Scottish patients, whereas, the more SMBG was conducted the better glycemic control resulted among type 2 diabetic patients who were on insulin. On the other hand,  a number of other studied indicated no remarkable effect of SMBG on glycemic control

In any respect, there is what seems to be a consensus between diabetologists that SMBG results contribute to the process of diabetes self-management and that some patients can apply these results to their overall treatment/. It is suggested that regular daily SMBG checking guides healthcare givers to modify medication plan. Moreover,  the American Diabetes Association (ADA) supports the idea of training diabetic patients to apply the SMBG results to their diabetes self-management program.

People with type 2 diabetes who are well trained, can use SMBG results to anticipate the occurrence of hypoglycemia. Patients who are treated with insulin should be trained to adjust the insulin dose according to SMBG results in order to lower the possibility of severe hypoglycemia and enhance their glycemic management at the same time. It is also essential to educate young kids/their families and adults on how to analyze the readings of SMBG to avoid the occurrence of hypoglycemia. Despite the lack of specific guidelines for monitoring blood glucose in children with type 2 diabetes, Copland stated some recommendations in this respect such as conducting blood glucose monitoring at least twice ( fasting and after eating). In the case of pregnancy, SMBG is essential in controlling gestational diabetes, according to ADA’s guidelines SMBG should be carried out fasting and after eating and in some cases also before eating. Furthermore, the National Institute for Health and Clinical Excellence advises pregnant women who happen to be diabetes patients to check their blood sugar levels fasting, and 1hr. after each meal all through the pregnancy course.

 

Everything about using SMBG 

 

  •  Types of  SMBG device

 

There are over 20 kinds of SMBG devices in the market at the moment of different weights, sizes, memory functions, measurement time …etc. Currently, most devices do the job in one or two steps with only drops of blood which helps in mitigating the pain and many of them are now provided with no-wipe technology. Besides more advanced devices allow patients to take blood samples from different spots other than the fingertip, yet there are doubts about the accuracy of the results based on using a different spot in detecting hypoglycemia, other devices are provided with features for observing the blood sugar pattern or record results in the form of graphs which is especially important for patients who check SMBG more than once a day.

 

 

  • Self-monitoring of blood glucose (SMBG) test:

 

 In this test the patient pricks his finger using a lancet to get drops of blood as a sample, which he then applies to  a reagent strip, after this he places this strip into a reflectance photometer to get the reading, SMBG device then stores the results, and the diabetic patient has to track these results to detect any changes in his blood sugar level and adjusts his insulin dose, carbohydrate consumption, … to bring his blood sugar level back to normal. This test is to be repeated several times a day/ a week according to the case. However, specialists recommend patients who receive insulin treatment to check their blood sugar level a minimum of 4 times per day (fasting, preprandial and before sleeping). Conducting the test after meals help patients to determine the accurate insulin dose they need. It is also established that frequent SMBG measurement enhances glycemic control for type 1 and type 2 patients who are treated with insulin

  • In the case of type 2 diabetes patients, the number of SMBG measurement changes according to the patient’s condition and medication plan. Patients whose condition is stable with diabetes within control do not need to conduct SMBG frequently while patients who have newly started medication or having trouble controlling their diabetes, frequent SMBG can help them plan their diabetic management. SMBG results are especially helpful in cases of frequent fasting hyperglycemia and postprandial hyperglycemia

 

Role of  diabetes educators:

  1.  Educating patients on how to select the appropriate blood glucose meter device, and training them on how to use it to ensure accurate readings. A diabetes educator is also responsible for evaluating the device accuracy and aptness, as well as, the patients’ approach on a regular basis, because the accuracy of such devices is usually influenced by factors like temperature and humidity, as well as, other factors attributed to the patient himself such as hypoxia, hematocrit, hypertriglyceridemia, consumption of concomitant medications. Diabetes educators should keep up to date on recent data concerned with the accuracy level of existing blood glucose meters to be able to guide the patients’ choice of the device.
  2. Negotiating with the insurance corporations and providers of the glucose blood meters on behalf of the patient to reach the best possible device fulfilling his needs. 
  3. Recognizing and dealing with obstacles that a patient may face when carrying out SMBG such as discomfort, experiencing pain, device cost, the lapse of memory, frustrating readings, weak language, and numeracy skills, receiving no support from the family, having a certain cognitive or physical impairment. Such obstacles require the diabetes educator’s attention, he may need to refer some patients or even patients’ attendants to specialists. The issue of pain or discomfort that the patient may experience when using the metering device, is probably overestimated.
  4. Helping in making a  decision concerning the ideal SMBG testing frequency according to the patient’s needs, treatment protocol and glycemic control level in line with the ADA, AACE, and AADE recommendations. A diabetes educator also advises patients on the proper action they should take in cases of taking a new medicine that is likely to affect the blood sugar level, sickness, stress…etc
  5. Without instructions from the diabetes educator, patients will not be able to make full benefit of SMBG readings as this requires proper monitoring of any changes in the blood sugar level and modification of dietary patterns, lifestyle or medicines according to the situation. Moreover, patients have to be aware of the blood glucose and A1C targets all day long i.e.  before and after eating 
  6. Enhancing the connection between the diabetic patient and his healthcare attendant in order for the SMBG results to be properly shared and analyzed. A diabetes educator is responsible for assessing the support a patient gets from people around him and offers more support if needed

 

The American Association of Diabetes Educators (AADE) recommendations:

  • Awareness on SMBG necessarily involves specific guidelines enabling the patient to detect the blood glucose levels which are not within the desired range, thereby to take the necessary procedures to bring them back to normal
  • In the event where obstacles hinder the  SMBG process, the frequency of  SMBG is to be determined by both the diabetes educator and the type2 diabetic patient, according to the patient requirements and condition.
  • The results of SMBG are to be shared among all healthcare personnel in order to reach the optimal decision concerning the patient’s treatment protocol
  • Since Self-monitoring of blood glucose (SMBG) is considered part and parcel of diabetes self-management, diabetes educator has to be an effective player in the patient’s diabetes team, who is in charge of making decisions about choosing the blood glucose meter device, training the patient on using the device, sharing and analyzing the device readings and finally making the necessary adjustments in the diabetes treatment plan accordingly.

 

Advantages VS.Disadvantages of Self-Monitoring Blood Glucose

 

Advantages  Disadvantages 
Guides the patient towards the  proper dietary pattern he should follow Experiencing pain when taking the blood sample
Raises the patient’s awareness of hypoglycemia Raising the patient’s concerns about his health condition and blood  sugar level 
Gives indications about the effectiveness of the medication plan Treatment cost
Notifies the patient when he should not perform dangerous actions which are likely to be influenced by  high or low blood sugar, like driving and operating machines
  • It should be noted that the above disadvantages may only occur if the patient does not have full awareness of using the device and analyzing its results or is not motivated enough to do the test

 

 

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