Fast Five Quiz: Type 2 Diabetes and Glucose Monitoring

Anne L. Peters, MD

Disclosures

January 27, 2022

BGM is particularly important for insulin-treated patients to monitor for and prevent hypoglycemia and hyperglycemia. According to the American Diabetes Association 2022 Standards of Medical Care, real-time CGM or intermittently scanned CGM should be offered to patients with diabetes on multiple daily injections or continuous subcutaneous insulin infusion who are capable of using devices safely (either alone or with a caregiver). Most patients using intensive insulin regimens (multiple daily injections or insulin pump therapy) should be encouraged to assess glucose levels using BGM and/or CGM in several scenarios, including:

  • Before meals and snacks

  • At bedtime

  • Occasionally postprandially

  • Before exercise

  • When they suspect low blood glucose

  • After treating low blood glucose until they are normoglycemic

  • Before or during performing critical tasks, such as driving

For many patients, this requires checking up to 6-10 times daily, although individual needs may vary.

Real-time CGM or intermittently scanned CGM can also be used for diabetes management in patients on basal insulin who are capable of using devices safely (alone or with a caregiver). A recent study showed that CGM, as compared with BGM, resulted in significantly lower A1c levels among patients with type 2 diabetes treated with basal insulin.

The evidence is insufficient regarding when to prescribe BGM and how often monitoring is needed for insulin-treated patients who do not use intensive insulin regimens, such as those with type 2 diabetes using basal insulin with or without oral agents. However, for patients using basal insulin, assessing fasting glucose with BGM to inform dose adjustments to achieve blood glucose targets results in lower A1c.

Many patients who check their blood glucose at least once daily report taking no action (ie, not making adjustments to diet, exercise, or medication) when results are high or low. Thus, patients should be taught how to use BGM data to adjust food intake, exercise, or pharmacologic therapy to achieve specific goals. Reevaluate the ongoing need for and frequency of BGM at each routine visit.

Learn more about glucose monitoring in type 2 diabetes.

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