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Sleep: zzzzzz…. are you sleeping well?

March 21, 2015 by Imagine_David Leave a Comment

“I slept so badly last night; I simply have no energy to exercise.”

What is Sleep Apnoea?

People with sleep apnoea stop breathing while they are sleeping. This causes them to wake up gasping and can happen as many as hundreds of times per night, although sleep apnoea sufferers do not usually remember waking up.

If you have sleep apnoea, your health may be in danger. People with sleep apnoea have higher chances of traffic accidents and are more likely to develop serious health problems. Sleep apnoea is a known cause of high blood pressure and can lead to to obesity.

Sleep apnoea can also cause relationship problems and depression.

Do I have sleep apnoea?

Usually, people with sleep apnoea find out because a spouse or bed partner noticed them snore or stop breathing during sleep. Other common signs and symptoms include:

Extreme sleepiness
Frequent snoring
Stopping breathing during sleep
Morning headaches
Depression
High blood pressure
Weight problems

Sleep apnoea is most common among men, people who are overweight and the middle-aged. However, research shows that children and post-menopausal women may also be at risk.

What is treatment like?

There are several treatments available for OSA (obstructive sleep apnoea), however most doctors recommend positive airway pressure (PAP) therapy. PAP therapy is safe, effective and non-invasive. It does not require drugs or surgery.

Alternatives including dental appliances may have some benefits for people with mild OSA. There are invasive surgeries available, however, they have variable success rates, and surgery always has a risk of short and long-term complications.

Of the available treatment options, PAP therapy is the safest and most effective. People on PAP therapy have reduced health risks and more energy to do the things they want to do.

**Talk to your doctor about having your sleep pattern assessed**

Health risks

Sleep apnoea can be life threatening. People with sleep apnoea have higher chances of serious health problems like diabetes, high blood pressure, heart disease, stroke and obesity.

Treating sleep apnoea can improve these problems, as well as a person’s overall quality of life. It has been shown to lower blood pressure, improve glucose control and increase energy throughout the day in people with diabetes.

The message is simple—if you have sleep apnoea, you need to get treated!

Diabetes

People with sleep apnoea have higher chances of developing insulin resistance, which can lead to Type 2 diabetes. Sleep apnoea is very common in patients that suffer from diabetes. Approximately 60% of Type 2 diabetes patients have sleep apnoea.

Diabetes patients who receive treatment for their sleep apnoea often have an immediate improvement in their diabetic condition.

If you have diabetes and think you might have sleep apnoea, you need to find out. Treating sleep apnoea can help you control your blood sugar levels and may lower your chances of complications, like heart disease.

High blood pressure

The (American)National Institute of Health lists sleep apnoea as a cause of high blood pressure.

Studies show that about 30% of all people with high blood pressure have sleep apnoea. That number increases to 80% for people taking three or more medications to control their blood pressure.

If you have high blood pressure and sleep apnoea, starting treatment may help you lower your levels significantly and improve your heart health.

Heart disease

Untreated sleep apnoea strains the heart and may cause it not to work properly.

Left untreated, sleep apnoea can lead to heart disease and heart failure.

People with sleep apnoea can lower their chances of developing these problems by getting treated. Sleep apnoea treatment can people help control their blood pressure and improve their heart health.

Stroke

Sleep apnoea can increase a person’s chances of stroke. In fact, studies show that more than 60% of patients who have had a stroke also have sleep apnoea. Stroke patients with untreated sleep apnoea may have a harder time recovering after a stroke than others do.

Recovering from a stroke takes much energy and motivation, but the sleepiness that comes from sleep apnoea can make it difficult for a person to follow rehabilitation programs, causing poor recovery.

Stroke patients with untreated sleep apnoea have higher chances of death than patients who receive treatment.

Obesity

About 40% of obese people have sleep apnoea. Overweight people should be particularly concerned because sleep apnoea may make weight loss more difficult.

The sleepiness that comes from sleep apnoea may cause people to overeat, sleep more, and exercise less. Some people, as a matter of habit, will eat to “wake up” when they feel drowsy during the day. That in turn can cause them to gain more weight, which may make their sleep apnoea even worse.

Being treated for sleep apnoea can help obese people gain the energy to exercise more and lose weight.

SLEEP QUIZ

This short quiz is designed to help you to recognize possible sleep apnoea so that you can realise there can be relief for your symptoms.

While awake

Do you wake up in the morning tired and foggy, not ready to face the day?
Do you have headaches in the morning?
Are you very sleepy during the day?
Do you fall asleep easily during the day?
Do you have difficulty concentrating, being productive, and completing tasks at work?
Do you carry out routine tasks in a daze?
Have you ever arrived home in your car but couldn’t remember the trip from work?

Adjustment and emotional issues

Are you having serious relationship problems at home, with friends and relatives, or at work?
Are you afraid that you may be out of touch with the real world, unable to think clearly, losing your memory, or emotionally ill?
Do your friends tell you that you’re not like yourself?
Are you depressed?
Are you irritable and angry, especially first thing in the morning?

Medical, physical condition, and lifestyle

Are you overweight?
Do you have high blood pressure?
Do you have pains in your bones and joints?
Do you have trouble breathing through your nose?
Do you often have a drink of alcohol before going to bed?
If you are a man, is your collar size 17 inches (42 centimetres) or larger?

During sleep and in the bedroom

Do you snore loudly each night?
Do you have frequent pauses in breathing while you sleep (you stop breathing for ten seconds or longer)?
Are you restless during sleep, tossing and turning from one side to another?
Does your posture during sleep seem unusual? (Do you sleep sitting up or propped up by pillows?)
Do you have insomnia? (Waking up frequently and without a reason)
Do you have to get up to urinate several times during the night?
Have you wet your bed?
Have you fallen from bed?

What is your score?

If you answered “yes” to any of these questions, you may have sleep apnoea.

However, if you answered “yes” to any of the following especially important four questions, this strongly suggests that sleep apnoea is the problem.

Are you very sleepy during the day?
Do you fall asleep easily during the day?
Do you snore loudly each night?
Do you have frequent pauses in breathing while you sleep (you stop breathing for 10 seconds or longer)?

Talk to your doctor today. More on sleep and diabetes HERE

Bon nuit / good night

Kind Regards,

David, Diabetes Educator @ Diabetes Counselling Online

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Case Study 1: George Mellows (1)

January 21, 2015 by Imagine_David Leave a Comment

Some things you can Control. Diabetes you can manage.

"Enjoying a good quality of life is my goal" George — “Enjoying a good quality of life is my goal”

George Mellows is aged 55. He lives with his wife and his two teenage children, aged 15 and 19.

George works Monday to Friday 8.30 am until 4.30 pm . He works at a desk in a sedentary role, getting minimal activity in his working day. George has not played any sport for some time, but he does enjoy playing lawn bowls.

4 weeks ago George was:

feeling excessively thirsty
was peeing more than normal
was feeling tired and lethargic
and was always feeling hungry

So, George went to visit his doctor. He described the symptoms, and his doctor sent him for a glucose tolerance test to test for diabetes. The results of this test confirmed a diagnosis of type 2 diabetes .

George was a little shocked as he has nobody in the family with diabetes, only a history of heart disease.

Until this diagnosis of type 2 diabetes George had no identified health problems.

Since his doctor discovered diabetes George has had some further blood work and had been found to have high cholesterol.

Measuring the Blood Glucose Level

George decided to start measuring his blood glucose levels as he was still feeling some symptoms, despite the doctor commencing George on Metformin 500mg in the evening with dinner. Table 1 below shows George’s blood glucose level test results.

George has yet to see a diabetes educator, dietitian, exercise physiologist or podiatrist.

Since starting the blood glucose level measurement George identifies, that despite commencing on Metformin, his blood glucose levels are above target.

Below is a table from the RACGP (Royal Australian College of General Practitioners) identifying the target blood glucose levels in type 2 diabetes. *Note: target blood glucose levels need to be individualised.

Targets for self-monitored glycaemic control in type 2 diabetes *

FBG (mmol/L)	Pre-prandial blood glucose (mmol/L)	Postprandial blood glucose (mmol/L)	Comment
6.0–8.0	6.0–8.0	6.0–10.0	NHMRC values

Based on his blood glucose levels after meal, George is concerned. He thought that taking his Metformin would be all that he needed to do. Now, he feels like he has failed.

George joined several groups of people living with diabetes on Facebook ( https://www.facebook.com/diabetes.counselling ) to see if he could glean some further understanding of diabetes self management.

“Self-management means having a daily management plan, setting goals, solving problems and taking responsibility. But it certainly does not mean you are on your own. Mutual trust and respect between yourself and your doctor and other members of the health care team, as well as regular communication with them, are vital to effective self-management.

Previously, traditional care was based on doctors and health professionals being seen as the experts responsible for the diagnosis and management of care. It was accepted that people’s lives should be fitted around their diabetes with goals set by the health professionals.

But this approach is not effective. Diabetes requires daily management. Doctors are not available every day, leaving responsibility for day-to-day care on the patient and the family.

In addition, good results are difficult to achieve if the person involved is not an active participant or does not understand the reasons behind management decisions.

Patient Empowerment takes a new approach. It moves the focus from the doctor to the patient. It involves fitting diabetes into your lifestyle with you making the choices and taking charge of your management and the consequences.” Diabetes Australia

Georges Plan:

Research diabetes and prepare questions for doctor, diabetes educator, dietitian.
Meet with diabetes educator:
“Diabetes educators are healthcare professionals who focus on helping people with and at risk for diabetes and related conditions achieve behavior change goals which, in turn, lead to better clinical outcomes and improved health status. Diabetes educators apply in-depth knowledge and skills in the biological and social sciences, communication, counseling, and education to provide self-management education/self- management training.” American Diabetes Association

“Diabetes educators specialise in the provision of diabetes self-management education for people with diabetes.

They provide support for people with diabetes, including gestational diabetes, integrating clinical care, self-management education, skills training and disease specific information to motivate patients to:
- Understand diabetes and make informed lifestyle and treatment choices
- Incorporate physical activity into daily life
- Use their medicines effectively and safely
- Monitor and interpret their blood glucose patterns” Allied Health Professions Australia
Meet with dietitian: appointment booked
Meet with doctor: appointment booked

George plans to ask about different treatment options.

Here are some questions George has prepared for his team:

Is this the best medication for me?

If I get any side effects what do I do? If this medication does not work, what’s next?

Do you mean ….. ? Is there anything I should not be doing?

How soon should treatment start ?

Can the treatment start next month when I am back from holidays?

Can I stop the treatment when I can’t afford it?

How much will the treatment cost?

What can I do to prevent further problems?

What can I do to keep my condition from getting worse?

How will making a change to my habits help me?

Are there support groups or community services that might help me?

Which other HCP’s will be able to help me manage this health issue?

Hand in hand with your health care professionals you van achieve a good quality of life with diabetes — Hand in hand with your health care professionals you can achieve a good quality of life when living with diabetes

Over to You

What advice would you give to George?

What was your experiences of being diagnosed with type 2 diabetes ?

How did you access your diabetes educator, dietitian, counsellor etc?

**** Added January 26: Part 2 HERE *****

Next time we visit George, we shall see how he is progressing with his diabetes self care plan http://www.diabetescounselling.com.au/choices-in-diabetes-management/

In the meantime, healthy days to you.

Kind Regards,

David, Diabetes Educator @ Diabetes Counselling Online

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Diabetic Nerve Damage: Neuropathy

January 11, 2015 by Imagine_David Leave a Comment

Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood glucose can injure nerve fibers throughout your body, but diabetic neuropathy most often damages nerves in your legs and feet.

Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in your extremities to problems with your digestive system, urinary tract, blood vessels and heart. For some people, these symptoms are mild; for others, diabetic neuropathy can be painful, disabling and even fatal.

Diabetic neuropathy is a common serious complication of diabetes. Yet you can often prevent diabetic neuropathy or slow its progress with tight blood glucose management, and a healthy lifestyle.

Clinical context

Pain and paraesthesia are common peripheral neuropathic symptoms, and if the autonomic nervous system is involved, gastrointestinal, bladder and sexual problems arise.

Diabetic neuropathic complications increase the burden of self-care and overall management.

The clinical focus is on prevention via good glycaemic control, and early recognition facilitated by good history and routine sensory testing.

New modalities are arriving to assist in the management of diabetic neuropathies.

Before any treatment is instigated, exclusion of non-diabetic causes of neuropathy is suggested. This includes assessment for vitamin B12 deficiency, hypothyroidism, renal disease and review of neurotoxic drugs including excessive alcohol consumption.

Autonomic neuropathy

Autonomic neuropathy may result in:

orthostatic hypotension (also called postural hypotension, is a form of low blood pressure that can cause dizziness. It happens when the blood vessels do not constrict (tighten) as you stand up, which makes you feel dizzy) with >20 mmHg drop
impaired and unpredictable gastric emptying (gastroparesis), which can cause a person’s blood glucose levels to be erratic and difficult to control. Pro-kinetic agents such as metoclopramide, domperidone or erythromycin may improve symptoms
diarrhoea
delayed/incomplete bladder emptying
erectile dysfunction and retrograde ejaculation in males
reduced vaginal lubrication with arousal in women
loss of cardiac pain, ‘silent’ ischaemia or infarction
sudden, unexpected cardiorespiratory arrest especially under anaesthetic or treatment with respiratory depressant medications
difficulty recognising hypoglycaemia
unexplained ankle oedema.

Cardiovascular autonomic neuropathy should be suspected by resting tachycardia (>100 bpm) or orthostatic reduction in BP (a fall in SBP >20 mmHg on standing without an appropriate heart rate response). This applies to people not currently on antihypertensive agents that may cause variations in BP responsiveness such as beta blockers. It is associated with increased cardiac event rates.

Diagnosis

The diagnosis of diabetic neuropathy may include:

taking a medical history for symptoms typical of neuropathy
checking your feet and legs for responses to stimuli such as temperature, light touch, pain, movement and vibration
checking the reflexes at your ankles and knees
tests to exclude other possible causes of neuropathy (such as low vitamin B₁or thiamine levels).

Treatment

Damaged nerves cannot be repaired. However, the risk of further complications in the feet can be reduced by:

vigilance – regular inspection of the feet for early signs of trouble or potential problem areas (such as breaks in skin, signs of infection or deformity
getting help at the first sign of trouble – early treatment of foot ulcers gives the best chance that they will heal
good foot and nail hygiene
choosing appropriate socks and shoes properly fitted to the shape of your foot
avoiding activities that may injure the feet. Check shoes for stones, sticks and other foreign objects that might hurt your feet every time before putting your shoes on.

A referral to a podiatrist may be appropriate for assessment and ongoing preventive management of foot complications.

Treatment for painful neuropathy

Appropriate pain management can significantly improve the lives of people with diabetes and painful neuropathy. A number of different medications are available, which produce comparable effects.

Most people would begin with one of either:

serotonin-norepinephrine reuptake inhibitors (such as venlafaxine, duloxetine)
tricyclics antidepressants (such as amityptiline)
anti-epileptics (such as gabapentin, pregabalin).

If one type fails to provide the response required, it is usual to switch to or add another. If all three agents alone or in combination fail, then opioid analgesics and tramadol may be used as second-line treatments.

Prevention of diabetic neuropathy

Be guided by your doctor, but general suggestions to reduce the risk of diabetic neuropathy include:

Maintain blood glucose levels within the target ranges.
Exercise regularly.
Maintain a healthy weight for your height.
Stop smoking.
Reduce your blood pressure and lipid (fat) levels through diet and lifestyle changes, and medication where appropriate
Consult your doctor promptly if you have symptoms including pain, numbness or tingling in your hands or feet.
Have your feet checked at least yearly by your doctor, podiatrist or diabetes educator, or more often if you have signs of problems with your feet or other complications of your diabetes.

Although, potential health complications due to diabetes may happen; don not live in fear, by watching the amount and types of food you eat, exercising, and taking any necessary medications, you may be able to prevent short and long-term diabetes complications.

Keeping blood glucose close to normal can help prevent the long-term complications of diabetes.
Manage high blood pressure.
Monitor your blood sugar level and A1c.
Have regular reviews with your diabetes care team.

Talk to your health care professional team: ask questions and get answers that you understand….. prevention is better than a decreased quality of life.

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Sleep & Diabetes

December 17, 2014 by Imagine_David Leave a Comment

How are you sleeping at night? All too often, the answer is the same: not well.

Diabetes and sleep problems often go hand in hand. Diabetes can cause sleep loss, and there’s evidence that not sleeping well can increase the risk of developing diabetes.

Symptoms

Symptoms associated with insufficient sleep include feeling tired, irritability, slurred speech, blurred vision, memory loss, inability to concentrate, episodes of confusion, hallucinations, nausea, impotence and reduced sexual drive. Extreme sleep deprivation can cause psychosis and death. However, there are no documented cases of a healthy human dying from sleep deprivation (although mortality from accidents does occur). Before death occurs in healthy, sleep-deprived humans, the brain forces itself to have ‘micro-sleeps’.

Evidence

In the past decade, there has been growing evidence that too little sleep can affect hormones and metabolism in ways that promote diabetes.

Current data suggests that the relationship between sleep restriction, weight gain and diabetes risk may involve at least three pathways: 1. alterations in glucose metabolism; 2. upregulation of appetite; 3. decreased energy expenditure. from The Metabolic Consequences of Sleep Deprivation

A 1999 Lancet study at the University of Chicago – the researchers monitored the blood glucose levels of 11 healthy young men who were allowed only four hours of sleep per night — from 1 a.m. to 5 a.m. — for six nights.

That study showed that after only a week of short bedtimes, their glucose tolerance was impaired. There could be dramatic effects even after only a week.

After 6 nights of little sleep, the men had higher-than-normal blood glucose levels. (The levels were not high enough to be diagnosed as diabetes, however). The effects went away once the men were back on their normal sleep schedule.

Experts also believe that chronic sleep deprivation may lead to elevated levels of the stress hormone, cortisol. Elevated cortisol may in turn promote insulin resistance, in which the body can’t use the hormone insulin properly to help move glucose into cells for energy.

Low Sleep = High Blood Sugar?

High blood glucose level is a red flag for sleep problems among people with diabetes.

Diabetes and sleep problems often go hand in hand. Diabetes can cause sleep loss.

If the blood glucose level is high the kidneys want to pass this excess glucose out in the urine. Getting up to pee in the middle of the night disturbs the sleep.

People who are tired will eat more because they want to get energy from somewhere. That may mean over-eating during the day > higher blood glucose level at night> getting up to pee>poor sleep etc etc.

Eating well throughout the day – having a safe and effective diabetes self care plan – to have your blood glucose level on target may have you be able to sleep better at night.

Low Sleep = Low Blood Sugar?

Conversely, having a hypo during the night is likely to wake you and destabilise your sleep.

A wise action to take would be to measure your blood glucose level occasionally at 2-3 am in order to exclude overnight hypoglycaemia.

The Link Between Lack of Sleep and Weight

Some studies show that people who get less sleep tend to be heavier than those who sleep well. People who are tired will eat more because they want to get energy from somewhere. That may mean over-eating during the day > higher blood glucose level at night> getting up to pee>poor sleep etc etc.

Sleep loss could also affect energy expenditure via its impact on the levels of leptin and ghrelin. Since several human studies have demonstrated reduced levels of leptin after sleep loss, it is possible that the reduction in leptin is associated with a reduction in energy expenditure. Similarly, the increase in ghrelin after partial sleep restriction could be associated with a decrease in NEAT (Non-exercise activity thermogenesis). *Experimental evidence is currently lacking to support either hypothesis*

Sleep Apnea?

There is also a link between diabetes and sleep apnea, a sleep disorder marked by loud snoring and pauses in breathing while you sleep. The culprit may be excess weight, which can cause fat deposits around the upper airway that obstruct breathing. So being overweight or obese is a risk factor for sleep apnea as well as diabetes.

If you have diabetes, are overweight, and snore, tell your doctor. You may need a sleep study.

Sleep apnea can prevent a person from getting a good night sleep, which can worsen diabetes. In sleep studies, you are monitored while you sleep for sleep disorders such sleep apnea.

There are many effective treatments for sleep apnea. These include lifestyle changes such as weight loss for mild cases and devices to open up blocked airways for more significant cases.

Sleep: How Important?

In general, people living with diabetes have to be very careful about sleep. Anything that throws off your routine can make you feel a lack of energy and fatigue. The more fatigued you feel, the more your motor is running, and the more likely you are to develop insulin deficiencies.

How Much Sleep?

On average, we need 7.5 hours per night, but your sleep requirement is genetically determined and varies.

It can be about four hours on the short end to 10 or 11 on the long end.

Want to know if you are sleep-deprived? The answer is simple…..If you use an alarm clock, you are. If you were getting adequate sleep, your brain would awaken you before the alarm goes off.

HELP

Improve your sleep habits: SNORE Australia

MJA (Medical Journal of Australia) Sleep Disorder Supplement

Australasian Sleep Association

So, turn off your electronic device…. and go get some sleep!

Kind Regards,

David,

Diabetes Educator @ Diabetes Counselling Online

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“I forgot to measure my BGL ….. “

December 5, 2014 by Imagine_David Leave a Comment

Exercise: you may find your blood glucose level has gone up immediately following exercise.

Do you use your blood glucose level meter like a compass, giving you some direction with your diabetes self care plan?

So, is missing an occasional blood glucose level a problem?

At a meeting of diabetes health care professional specialists a few years ago I met an endocrinologist specialising in the diabetes management of young people living with diabetes. This specialist stated that she didn’t really mind if her patients measured their blood glucose level between visits…… except for the 2 weeks immediately prior to the visit. For these measurements were the current ones – that bgls that she would base any treatment changes on.

Testing

Among other things, a measured pattern of your blood glucose levels will help you to:

Develop confidence in your diabetes self care plan

Develop a improved understand of the relationship between your blood glucose levels the factors that effect them: e.g. physical activity, food you eat, stress and illness.

Explore if your diabetes medication, if used, is safe and effective in helping you reach your blood glucose level targets.

Assess in critical situations if your blood glucose levels are in the extremes and require immediate management

**Your meal choices are ONLY one factor that will effect your blood glucose level**

Frequency

For any individual with diabetes, personalised education by qualified and experienced health care professionals in appropriate blood glucose targets and timing of SMBG, interpretation of documented SMBG serial profiles and trends across and between days, is essential.

Suggested patterns of testing could be :

1) You may test before and 2 hours after meals on 3-4 consecutive days to establish your current pattern. If you identify that your blood glucose levels are off target, more testing maybe required in order to make appropriate adjustments to your diabetes self care plan.

2) For people with type 2 diabetes – You test once per day moving the test each day forwards by one appropriate time e.g Monday before breakfast, Tuedsay after breakfast, Wednesday after lunch, Thurdsay after dinner, Friday before breakfast and so on. After a few weeks you can then assess the pattern.

3) Before and after a new meal: this will give you some idea of how your body is adjusting to this new meal. You may have changed the type of food you eat, or the volume of the carbohydrate in your meal based on advice from your dietitian.

4) Before, after, during exercise: assessing your risk of hypoglycaemia and your bodies reaction to the exercise.

If your bgls are on target you may the test less frequently, or/and only when you are thinking you may be hypoglycaemia or sick.

*For people with type 1 diabetes, avoiding DKA is essential when sick – in this situation follow your sick day plan.*

What’s Recommended?

Blood glucose targets: from HERE – Australasian Paediatric Endorcine Group, 2011

For adults in the intensively treated group of the DCCT, blood glucose targets were:

Before meals 3.9 to 6.7 mmol/L
After meals 5 to 10 mmol/L
At 3am (weekly) above 3.6 mmol/L

For young people with type 1 diabetes, targets are (Ambler and Cameron 2010):

Before meals 4 to 7 mmol/L
After meals 5 to 10 mmol/L
At bed time 6 to 10 mmol/L
At 3am 5 to 8mmol/L

Blood glucose targets may be set higher for infants and young children:

Before meals 5 to 10 mmol/L
After meals 6 to 10 mmol/L
At bed time 6 to 12 mmol/L

** It is emphasised that blood glucose targets need to be individualised for each person with type 1 diabetes. Clinical trials targeting intensive blood glucose control such as the DCCT typically exclude people at highest risk of severe hypoglycaemia, with advanced end‐stage diabetes complications, with poor adherence to therapy or with major intercurrent medical conditions (DCCT Research Group 1993). The average duration of diabetes was only 2.6 years at study entry in the intensive treatment arm of the DCCT, for the average 6.5 years’ study duration. Thus, the DCCT and EDIC mainly examined the importance of tight glycaemic control in the first 10 years after diabetes diagnosis. In contrast, glycaemic control typically becomes more difficult to achieve safely with increasing diabetes duration of, and both a lack of hypoglycaemia awareness and severe hypoglycaemia become increasingly common.

“A 2012 Cochrane review75 on the effect of SMBG in patients with type 2 diabetes not using insulin found limited clinical benefit as measured by HbA1c from SMBG and no evidence that SMBG affects patient satisfaction, general wellbeing or general health-related quality of life.

Self-monitoring is usually recommended:

for patients on insulin and oral hypoglycaemic agents (OHAs) that can cause hypoglycaemia
when monitoring hyperglycaemia arising from illness
with pregnancy, as well as pre-pregnancy planning
when changes in treatment, lifestyle or other conditions requires data on glycaemic patterns
when HbA1c estimations are unreliable (e.g. haemoglobinopathies).

The method and frequency of monitoring need to reflect individual circumstances and therapeutic aims and where the person with diabetes and their healthcare providers have the knowledge, skills and willingness to incorporate self monitoring of blood glucose levels and therapy adjustments into diabetes care plans.

In practice

Recommendations	Reference	Grade*
Blood glucose control should be optimised because of its beneficial effects on the development and progression of microvascular complications	(71) NHMRC, 2009	A
The potential harmful effects of optimising blood glucose control in people with type 2 diabetes should be considered when setting individual glycaemic targets	(71) NHMRC, 2009	A
The general HbA1c target in people with type 2 diabetes is ≤7% (≤53 mmol/mol). Adjustments to diabetes treatment should be considered when HbA1c is above this level	(71) NHMRC, 2009	A
Targets for SMBG levels are 6–8 mmol/L fasting and pre-prandial, and 6–10 mmol/L 2 h postprandial	(71) NHMRC, 2009	C

” from HERE – RACGP General Practice management of type 2 diabetes 2014-15

Goals

What are your goals? For most people goals are very ‘soft’ e.g “I want normal blood glucose level’s”

Something more specific may be “I want to avoid hypoglycaemia” or “I don’t want any blood glucose levels over 15 mmols”

You may want to consider how to write effective goals that are specific and time limited. For example:

“In the next 3 months, (between now and my next HbA1c test) I shall measure my blood glucose level every week for 3 days when I wake up, and also before and after each meal. If my bgls are over target I shall test daily for a week and show the results to my GP”

Missing an occasional test is not going to change this goal. The more information you can provide to yourself the more likely it is that your diabetes self care plan will be safe and effective.

**Regular assessment of your blood glucose level can help you with your quality of life**

Kind Regards,

David

Diabetes Educator @ Diabetes Counselling Online

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