Blood glucose monitoring is a method of testing the glucose concentration in the blood (glycemia). Particularly important in diabetes management, blood glucose testing is usually done by piercing the skin (usually, on the finger) to draw blood, then applying blood to a chemically tested 'test-strip'. Different manufacturers use different technologies, but most systems measure electrical characteristics, and use them to determine glucose levels in the blood. This test is usually referred to as capillary blood glucose.
Healthcare professionals advise patients with diabetes mellitus on a monitoring regimen appropriate for their condition. Most people with type 2 diabetes at least once a day. The Mayo Clinic generally recommends that insulin-free diabetics (all type 1 diabetics and many people with type 2 diabetes) test their blood sugar more often (4-8 times per day for type 1, 2 or more times per day for type 1 diabetes) type 2 diabetes), both to assess the effectiveness of previous insulin doses and to help determine the next dose of insulin.
Video Blood glucose monitoring
Destination
Blood glucose monitoring reveals the individual pattern of blood glucose changes, and helps in planning meals, activities, and hours of how much to take medication.
In addition, testing allows rapid response to high blood sugar (hyperglycemia) or low blood sugar (hypoglycemia). This may include adjusting diet, exercise, and insulin (as instructed by health care providers).
Maps Blood glucose monitoring
Blood glucose meter
A blood glucose meter is an electronic device to measure blood glucose levels. A relatively small drop of blood is placed on a disposable test strip that interacts with a digital meter. In a few seconds, blood glucose levels will be displayed on a digital screen.
Just requiring a drop of blood for a meter means that the time and effort needed for testing is reduced and diabetic adherence to their test regimen is increased. Although the cost of using blood glucose meter seems high, it is believed to be a relative cost benefit against the medical costs that are avoided from diabetic complications.
Recent advances include:
- alternative site testing , the use of blood droplets from places other than fingers, usually the palm of the hand or forearm. Testing these alternative sites uses the same strip and meter tests, is practically pain free, and gives real estate on the fingertips the breaks are necessary if they become ill. The disadvantage of this technique is that there is usually little blood flow to the surrogate site, which prevents accurate readings when blood sugar levels change.
- no encoding system . Older systems require 'coding' from strip to meter. This carries the risk of 'miscoding', which can lead to inaccurate results. Two approaches have resulted in systems that no longer require coding. Some 'autocoded' systems, where technology is used to encode every strip into the meter. And some are made for 'single code', thus avoiding the risk of typos. multi-test
- multi-test system. Some systems use cartridges or discs that contain multiple test strips. It has the advantage that users do not need to load individual strips every time, which is convenient and can enable faster testing.
- can be downloaded meter. Most newer systems come with software that allows users to download the results of a meter to a computer. This information can then be used, along with health care professional guides, to improve and improve diabetes management. Meters typically require a connection cable, unless they are designed to work wirelessly with an insulin pump, designed to be connected directly to a computer, or using an infrared connection.
Continuous glucose monitoring
A continuous glucose monitor (CGM) determines glucose levels continuously (every few minutes). Typical systems consist of:
- a disposable glucose sensor is placed just below the skin, which is used for several days until replacement
- links from sensors to non-implanted transmitters communicating to radio receivers
- a worn electronic receiver such as a pager (or insulin pump) that displays glucose levels with almost continuous updates, and monitors the up and down trend.
Continuous glucose monitors measure the concentration of glucose in interstitial fluid samples. The shortcomings of the CGM system due to this fact are:
- sustainable systems should be calibrated with traditional blood glucose measurements (using current technology) and therefore require CGM systems and sometimes "fingerstick"
- levels of glucose in the interstitial fluid lag behind the value of blood glucose
Therefore patients require traditional fingerstick measurements for calibration (usually twice per day) and it is often recommended to use fingerstick measurements to confirm hypo- or hyperglycemia before taking corrective action.
The break time discussed above has been reported for about 5 minutes. Anecdotally, some users of various systems report a lag time of up to 10-15 minutes. This break time is not significant when blood sugar levels are relatively consistent. However, blood sugar levels, when changed rapidly, can read within the normal range of the CGM system while in fact the patient has experienced symptoms of blood glucose values ââout of reach and may require treatment. Patients who use CGM are advised to consider both the absolute value of blood glucose levels provided by the system and any trends in blood glucose levels. For example, a patient who used CGM with 100 mg/dl blood glucose on their CGM system may not take action if their blood glucose has been consistent for some readings, while patients with the same blood glucose level but whose blood glucose have dropped sharply in a short period of time it may be advisable to perform a fingerstick test to check for hypoglycemia.
Continuous monitoring allows examination of how blood glucose levels react to insulin, exercise, food, and other factors. Additional data can be useful for adjusting the proper dose of insulin dose for food intake and correction of hyperglycemia. Monitoring during periods when blood glucose levels are usually not checked (eg overnight) may help identify problems in insulin doses (such as basal rates for insulin pump users or long-acting insulin levels for injection-prone patients). The monitor may also be equipped with alarms to alert patients of hyperglycemia or hypoglycemia so that patients can take corrective action (after fingerstick testing, if necessary) even in cases where they do not feel the symptoms of both conditions. While technology has limitations, studies have shown that patients with continuous sensors experience less hyperglycemia and also reduce their glycosylated hemoglobin levels.
Currently, continuous blood glucose monitoring is not automatically protected by health insurance in the United States in the same way as most other diabetes supplies are covered (eg standard glucose testing supplies, insulin, and even insulin pumps). However, more and more insurance companies cover continuous glucose monitoring supplies (both recipients and disposable sensors) on a case-by-case basis if patients and physicians demonstrate special needs. The lack of insurance coverage is compounded by the fact that disposable sensors need to be replaced frequently. Some sensors have been approved by the US Food and Drug Administration (FDA) for 7- and 3-day use, although some patients use the sensor longer than the recommended period) and the meter receiver also has a limited lifespan (less than 2 years and slightly as 6 month). This is one factor in the slow uptake in the use of sensors that have been marketed in the United States.
The principles, history and recent development of electrochemical glucose biosensor surgery are discussed in a chemical review by Joseph Wang.
Bio-implanted glucose sensing
Investigations on the use of test strips indicate that the necessary self-injury measures as a psychological barrier hold patients from adequate glucose control. As a result, secondary disease is caused by excessive glucose levels. A significant increase of diabetes therapy can be achieved with implant sensors that will continue to monitor blood sugar levels in the body and transmit measured data on the outside. The burden of regular blood tests will be taken from patients, who would otherwise follow their glucose levels on smart devices such as laptops or smart phones.
Glucose concentration should not be measured in blood vessels, but may also be prescribed in interstitial fluid, where the same level applies - with a lag time of several minutes - due to its relationship with the capillary system. However, enzymatic glucose detection schemes used in disposable test strips are not directly suitable for implants. One major problem is due to the varying supply of oxygen, in which glucose is converted into glucono lactone and H 2 O 2 by glucose oxidase. Because the implantation of the sensors into the body is accompanied by the growth of the encapsulation tissue, the diffusion of oxygen into the reaction zone continues to decrease. The decreased availability of oxygen causes the readings of the floating sensors, which require repeated calibration using stick-finger and test strips.
One approach to achieving long-term glucose sensing is to measure and compensate for changes in local oxygen concentrations. Another approach replaces the troublesome glucose oxidase reaction with reversible sensing reactions, known as affinity tests. This scheme was originally proposed by Schultz & amp; Sims in 1978. A number of different affinity tests have been investigated, with fluorescent tests proving most common. Recent MEMS technology allows for smaller and more convenient alternatives for fluorescent detection, through viscosity measurements. Investigation of affinity-based sensors has shown that encapsulation by body tissues does not lead to the exclusion of sensor signals, but only time interval of the signal is compared with direct measurements in the blood.
Non-invasive technology
Some new technologies to monitor blood glucose levels will not require access to the blood to read glucose levels. Non-invasive technologies include near IR detection, ultrasound and dielectric spectroscopy. This can free people with diabetes from a finger stick to supply a drop of blood for blood glucose analysis.
Most non-invasive methods under development are continuous glucose monitoring methods and offer the advantage of providing additional information for the subject between a conventional finger stick, blood glucose measurement and a time period in which no measurement of the stick finger is available (eg while the subject is sleeping ).
Effectiveness
For patients with type 2 diabetes mellitus, the importance of monitoring and optimal frequency of monitoring is unclear. A 2011 study found no evidence that blood glucose monitoring leads to better patient outcomes in actual practice. One randomized controlled trial found that self-monitoring of blood glucose did not increase glycosylated hemoglobin (HbA1c) among non-insulin treated patients with well-controlled type 2 diabetes. However, a recent meta-analysis of 47 randomized controlled trials covering 7677 patients showed that self-care management interventions improved glycemic control in diabetics, with an estimated reduction of 0.36% (95% CI, 0.21-0.51) at their glycosylated hemoglobin values. In addition, a recent study showed that patients described as "Uncontrolled Diabetes Patients" (defined in this study by HbA1C level & 8%) showed statistically significant decreases in HbA1C levels after a 90-day self-monitoring period of seven points. blood glucose (SMBG) with relative risk reduction (RRR) 0.18% (95% CI, 0.86-2.64%, p & lt;.001). Regardless of the value of the lab or other numerical parameters, the purpose of the physician is to improve the quality of life and outcomes of patients in diabetic patients. A recent study involved 12 randomized controlled trials and evaluated outcomes in 3259 patients. The authors concluded through qualitative analysis that SMBG on quality of life did not show any effect on patient satisfaction or quality of life related to patient health. Furthermore, the same study identified that patients with type 2 diabetes mellitus who were diagnosed more than one year before SMGD initiation, who did not use insulin, had statistically significant decreases in their HbA1C of 0.3% (95% CI, -0, 4 - - 0.1) at six months of follow-up, but a statistically significant reduction of 0.1% (95% CI, -0.3-0.04) at twelve months of follow-up. In contrast, newly diagnosed patients had a statistically significant decrease of 0.5% (95% CI, -0.9 - -0.1) at 12 months of follow-up. A recent study found that an intensive blood glucose reduction strategy (under 6%) in patients with additional risk factors for cardiovascular disease is more dangerous than benefits. For people with type 2 diabetes who do not use insulin, exercise and diet is the best tool. Blood glucose monitoring, in this case, is just a tool for evaluating diet and exercise success. People with insulin-dependent type 2 diabetes do not need to monitor their blood sugar as often as type 1 diabetics.
Recommendations
The National Institute for Clinical Health and Excellence (NICE), UK released an updated diabetes recommendation on May 30, 2008, which recommends that self-monitoring of plasma glucose levels for people with newly diagnosed type 2 diabetes should be integrated into a structured self-management education. process. Recommendations were updated in August 2015 for children and young adults with type 1 diabetes. See: NICE Guide for Continuous Blood Glucose Monitoring.
References
Source of the article : Wikipedia