Monitoring for Better Control
In years past, diabetics at home had to rely on urine testing to tell them if their sugar level was too high. But that didn’t tell them if they had too little sugar in their bloodstream. They couldn’t tell if they were heading for a hypoglycemic reaction.
Urine testing for sugar, although it is still used by some diabetics, has other disadvantages. First of all, urine flows into the bladder gradually, as it is produced by the kidneys. Because of this, when a person passes urine for testing, it may be the collection of the past two or three hours. The blood sugar level changes much more quickly than that. This means that the urine test result may actually tell what was happening an hour or two ago, but it does not tell what is happening now. And what’s going on now is what is really important.
Furthermore, some people’s kidneys are more likely to reabsorb sugar into the bloodstream rather than let it be lost and excreted in the urine. Thus they may have quite a high blood sugar level while the urine tests are still negative. A doctor friend of mine has observed that this tends to be more common in Asians than in other groups. This same doctor once had a patient with a blood glucose level of 600 mg percent while urine tests still showed no sign of sugar.
In times past, the only way a diabetic could know his actual blood glucose level was to go to the doctor’s office, to a laboratory, or to the hospital to have it checked.
Urine Testing Is Still Important
Even though urine tests are no longer the best way to test for sugar, they are still very necessary. Urine testing is the only way that a diabetic can know if his body is producing any ketones. Ketones in the urine are a danger signal that the diabetic may be heading toward a serious condition known as ketoacidosis. We will take a closer look at ketoacidosis in the chapter on diabetic emergencies.
The doctor or nurse will advise the diabetic how often he should test his urine for ketones. He must test for ketones even more frequently, however, if he is sick. He should also check for ketones if he has any of the following symptoms:
*He constantly feels tired or sleepy
*His mouth is very dry
*He feels thirsty
*His breath smells fruity
*He has difficulty with breathing
*His skin is reddish
*He begins vomiting
*He has difficulty paying attention
*He acts or feels confused
*His blood sugar stays above 240mg/dl for any length of time
If a diabetic tests and finds a large amount of ketones in his urine, he should call his doctor immediately or go the nearest hospital emergency room.
Besides testing for ketones, however, many people do still use urine testing for sugar. That is a decision that the patient and his doctor will need to make together. For the most accurate results, it is best to completely empty the urinary bladder, drink a large glass of water, then urinate again after about 15 or 20 minutes and test this later urine sample.
Some diabetics who regularly test their blood glucose also test their urine for sugar. They find that by testing both, they are able to have ever better control of their diabetes.
Urine testing is actually quick and easy to do. Some types of urine tests may take longer than others, but the actual testing can usually be completed within two minutes or less.
One bit of caution is very important. Just as all medicines should be kept out of the reach of children, wherever urine testing tablets are still used, they must also be kept where children cannot reach them. They are poisonous.
New tests are also being developed for diabetes care. Major medical centers and even some modern doctors’ clinics are beginning to screen their diabetic patients for microalbuminuria, a kind of protein the blood. Testing for microalbuminuria can show early signs of kidney problems in some diabetics. Such tests can provide an early warning so that doctors can help their patients to prevent serious kidney damage. Who knows, one of these days scientists may develop a simple home test for microalbuminuria. For the time being, however, it looks like that will be at least a few more years away.
Self-monitoring of Blood Glucose—SMBG
Today, many diabetics—especially those who must take insulin—test their own blood with a small monitoring device. Doctors call this “self-monitoring of blood glucose”, or “SMBG”.
There are two methods of self-monitoring. In one method, the diabetic puts a drop of his blood onto a special test strip, then compares the color on the strip with the color on a chart. The color chart tells approximately what the blood glucose level is. For someone whose eyesight is not good, however, this method is not reliable.
The other method is easier to use and is more accurate, although it is more expensive. Using a glucose meter, the diabetic takes the strip of special testing paper with his drop of blood on it, and inserts it into the meter. The little glucose meter screen shows what the blood glucose level is. (Some meters even read it out loud so the person can hear the report.)
There are several brands of glucose meters on the market today. All of them run on batteries, and all are quite small and easy to carry. A doctor who treats many diabetics is likely to recommend a particular type of monitor because it is more reliable and accurate or because it is easier to use.
When buying a glucose meter, it is important to find out all the costs before deciding which to get. A brand which seems less expensive to purchase may actually be more costly to maintain and buy the rest strips for. (Some hospitals or diabetes associations own several monitors and loan them out to patients who cannot afford to buy monitors for themselves.)
Once a diabetic decides to monitor his blood, he must learn how to use his particular machine correctly. If a person uses the wrong technique, or if he does not do each step at the right time, he is likely to get an incorrect reading.
Doesn’t it hurt, though, to have to prick your finger to get a drop of blood every time? In reality, the fear is the worst part—much worse than the actual prick, regardless of whether you’re young or old. But I recently read a cute idea for making it easier. A little six-year-old diabetic suggested putting a wooden clothespin on his finger before pricking. Besides making a bit of a game out of the routine, it made the drop of blood come out more easily, and it also helped take away the pain.
Why should a diabetic go to all the trouble and expense of monitoring his blood sugar level?
You could look at it this way: It’s much cheaper to monitor than it is to go to the hospital if diabetes gets out of control! And it is far less painful and troublesome to monitor than it is to live with blindness, kidney failure, heart disease, or any of the other serious complications which can come from having poorly controlled diabetes.
Many diabetics—especially those who must use insulin—want to try to keep their blood sugar level the same as a nondiabetic’s blood sugar level. We call this keeping tight control.
Being able to check the blood glucose level at any time of day or night, the diabetic can adjust the amount and the time of taking food, exercise and even medicine. For example, let’s say that he has just returned from exercise. He tests his blood and finds that his blood sugar level is quite low. Knowing that, he can immediately take some food or juice to put more glucose into his blood. By doing this, he can avoid a hypoglycemic reaction.
If, instead, he finds that his blood sugar level is higher than it should be, he may decide that he should exercise for an extra few minutes. He may decide not to eat as much as he had planned. Or, if his doctor has given him permission to make minor adjustments in his medicine dosage, he may decide to take a little more insulin or oral medication.
Who Should Monitor?
The American Diabetes Association especially recommends monitoring for certain people:
*Those who use insulin and frequently have hypoglycemic reactions, or very low blood sugar.
*Any diabetics who do not recognize the warning signs of hypoglycemia. As some diabetics get older, the warning signals may become less or may disappear completely.
*Those who take very large doses of insulin.
*Anyone who is struggling to gain control of his diabetes, or anyone who simply wants to keep good, tight control.
*Any diabetic woman who wants to become pregnant or who is already pregnant. Keeping tight control is very important to having a healthy pregnancy and a healthy baby.
*Anyone who uses an insulin pump.
*Diabetics whose kidneys “spill” sugar into the urine at an unusually high or low level of blood sugar. In such cases, it is more difficult to get accurate urine test results.
*Anyone who is sick, has any kind of infection, or is under unusually severe stress.
As you can see, blood glucose monitoring—SMBG—is important for anyone who is taking insulin, usually type I diabetics. With type II diabetes, in which the body does still produce some insulin, the blood sugar does not generally change so greatly during the day or from one day to the next.
This does not mean, however, that type II diabetics should not monitor. Type II diabetics are major candidates for serious complications from high blood sugar. And they, too, may be surprised by hypoglycemic reactions. Monitoring can help them keep better control.
Keeping a Diabetic Diary
Soon after diagnosis, a diabetic should begin to keep a diary. Not the usual kind of diary expressing our most personal feelings or what we did or saw during the day. The very simplest diary would be nothing more than the times and results of blood glucose testing plus the times, types and doses of insulin each day.
If a diabetic is having trouble with his blood sugar control, he should also take not of what he eats, how long he exercises, if he is ill, and any other unusual circumstances.
Having a good record of all these items will help the diabetic to figure out what may have caused low or high blood sugar on a particular day. If he can see a pattern in his blood glucose records, it will help him to control his diabetes better and to prevent problems in the future.
Diabetic diaries, or logbooks, are often available from diabetes associations or clinics, hospitals, or companies which produce diabetes medicines. A typical page of a very simple diabetes diary may look something like the one below.
A diabetic should take his diary with him whenever he goes to see the doctor. The doctor can see how the diabetic is getting along and know whether or not to make changes in the patient’s diet, exercise, or type or dose of diabetes medicines.
Every diabetic needs to monitor, just to make sure he’s getting along okay. Someday it may be even easier. Right now, scientists are working on something like a wristwatch that will test the blood glucose level without every puncturing the skin. Who knows what tomorrow will bring. But for now, testing each day may help keep the doctor away!