Monday, February 4, 2013

Home glucose test . Which test to test ?


 Your doctor and insurance carrier recommended testing  at least once or twice daily.

   chose your test wisely
         # 1   2 to 3 am glucose
          #2    fasting glucose
          #3    before lunch
          #4    before dinner
          #5    bedtime
          #6    1 or 2 hours after meals

     
     From the list above , rate the test as to its value in managing your 
    diabetes.

           first ____   second____  third____ fourth____  fifth ____  Sixth____ 

   
My choices
         - first choice is - Fasting blood glucose a good indicator of your basal insulin production )
         - second choice - 3 am glucose ( the time of day when you are the most sensitive to insulin )
         - third choice - before dinner ( after noon hypoglycemia is common )
         - forth choice - bed time ( after dinner snacks may be a issue )
        -  fifth  choice - before lunch  ( if you are high before breakfast , you will probable be high before lunch )                        
        -  sixth choice -1 or 2 hours after a meal  ( not of much value unless your A1c is below 7.5 and and you are
                                                                                                           trying to reach 6 )

                       
      What would you do if your choice of test is above or below your
     recommended target goal 

       It may depend on which test is not in the target range

            Low fasting glucose - check 2 or 3 am glucose for 2 to 3 days days to rule out unrecognized hypoglycemia.
                                               
            Persistent high fasting glucose - indicates basal insulin deficiency

            Low 3 am test - you may be at risk of a severe insulin reaction

            High 3m test -   Test your bedtime sugars and reevaluate your bedtime snack

            Third, forth and fifth choice - are effected by your glucose test before the previous meal and, amount of
                                                                                    carbohydrates eaten at  that meal and your diabetes meds.
                                                                                    

        Ideal - Switch from your routine to a diagnostic Testing ?

           Diagnostic testing
              Testing before each meal , bedtime and 3 AM and look for a *patterns.
             
    Tomorrow --  more on patterns with a few examples
   
    Question - What time of day are you the most resistent to the effects of insulin ?

Have fun ,  Be  smart and focus on basic diabetes management skills
David Calder, MD
       

       *  Pattern defination - a combination of glucose results forming a consistent arangement


         
       

              
           

   


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Your comments and questions are appreciated. David Calder,MD