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Diabetes - Monitoring

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For monitoring to be worthwhile the results need to be applied to treatment changes and / or managing lifestyle.

Monitoring is an important element to patient empowerment in diabetes.

Rationale for Monitoring

To inform the patient and the healthcare professional of the status of the glycaemic control and to guide treatment changes and the management of unusual circumstances such as illness or travel.

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Self Blood Glucose Monitoring

See - Recommendations from Bedfordshire Joint Prescribing Committee

Type 2 Diabetes on Diet/Exercise alone or Oral Medication

Blood glucose monitoring is not necessary for all people with Type 2 diabetes.

However it can be useful:

To assess the effect of changes in dietary, therapeutic and exercise regimens on blood glucose control.

Where urine testing does not adequately reflect glucose control (HbA1c).

When urine results are consistently positive to glucose despite changes in medication.

Adjustments of oral medication by patient or healthcare professional.

In times of intercurrent illness.

Where hypoglycaemia is suspected

As part of pre-pregnancy care (mandatory).

Type 2 Diabetes on Insulin

Regular testing is recommended at the time of starting insulin (usually 2 to 4 tests a day).

When glucose levels are under control then testing can be reduced in frequency but remains an important tool in managing their diabetes. 3-4 tests per week at differing times may be adequate.

Regular review of the way in which patients utilise their blood glucose readings in adjusting their treatment or making lifestyle changes is advised.

Increased testing is advised during times of illness.


Type 1 Diabetes

It is recommended that blood glucose levels are monitored in all people with Type 1 Diabetes.

The frequency and timing of these tests will depend on the motivation of the individual and the insulin regime. A management plan should be developed and agreed with the patient.

Increased testing is recommended during pregnancy and intercurrent illness and during major lifestyle changes

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Home Urine Testing


Gives less accurate results than blood testing but can be adequate when control is stable in those patients on diet/exercise or oral medication.

It is recommended that patients test regularly usually at least 3 times a week at varying times.

Urine testing needs to be used in conjunction with HbA1c as a guide to overall control.

Disparity between urine test results and HbA1c levels or clinical concerns about hypo- or hyperglycaemia will normally need blood glucose monitoring to resolve the situation.

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Ketone Testing


Patients with Type 1 Diabetes are advised to test for ketones during intercurrent illness. There is no need to routinely test for ketones. Urine ketone sticks are available. Blood ketone strips are now available.

The ability to check for ketones may be important in certain newly diagnosed patients where the type of diabetes is unclear. If ketones develop then this is a warning that the need for insulin is assessed urgently (refer to specialist team).

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Haemoglobin A1c (Glycated Haemoglobin)


This gives an indication of the prevailing blood glucose levels over the preceding 8-12 weeks.

It should be performed at least 6 monthly in all patients however in certain circumstances such as pregnancy, in children or after alteration of treatments, more frequent measurement is helpful.

HbA1c has no place in the diagnostic process.

Co-existing haemoglobinopathies may give misleading results.

There is no benefit in repeating the HbA1c at less than 3 monthly intervals.

Research evidence suggests a target level of <53 mmol/mol for the avoidance of long term complications and <48 mmol/mol if complications are present. The current QoF target in <58 mmol/mol

Research evidence shows that any reduction of HbA1c level is of benefit even if target levels are not reached.

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Useful External Links & Resources

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Diabetes UK Leaflet: HbA1C Standardisation for Clinical Health Care Professionals

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Diabetes UK Leaflet: A Change in Reporting HbA1C results. Information for People with Diabetes

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What does HbA1c mean?

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Recommendations from Bedfordshire Joint Prescribing Committee

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Patient Leaflet for Blood Glucose Monitoring in Type 2 Diabetes
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