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Glucose Monitoring Where we have been, where we need to be

Glucose Monitoring Where we have been, where we need to be. In 1500 B.C ., high glucose was indentified by ants going to a persons urine In 400 B.C ., physicians were tasting urine to diagnose diabetes “Water tasters” used to diagnose up until the 17th century

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Glucose Monitoring Where we have been, where we need to be

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  1. Glucose Monitoring Where we have been, where we need to be • In 1500 B.C., high glucose was indentified by ants going to a persons urine • In 400 B.C., physicians were tasting urine to diagnose diabetes • “Water tasters” used to diagnose up until the 17th century • 1776 - sugar actually identified in the urine by Matthew Dobson • Early 1800s: first chemical tests to detect sugar in urine • 1915 - Benedict's reagent is used as a test for glucose in urine - testing becomes more common. • 1941- Clinitest tabs are available and you can boil urine and get a quantitative glucose value

  2. Fast Test Time – most 5 seconds or less • Small Blood Sample – 0.3- 0.7 microliters • Alternate Site Testing - Decreases pain associated with testing • No Coding Needed - Accurate and precise tests Now Glucose Monitor Accuracy Is Good, Sample Size Is Small and Coding Is Not Necessary

  3. Diabetes “Report Card” Self-Monitoring of Blood Glucose Among Adults With Diabetes — United States, 1997–2006 Only 60% of Americans with diabetes measure their blood glucose levels! The Average Type 2 patient checks their glucose 0.6 times a day Centers for Disease Control and Prevention. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/mm5643a3.htm. Accessed January 25, 2008

  4. Top four reasons for not monitoring: • Finger soreness (492) • Pain (428) • Inconvenience (347) • Fear of needles (117) University of New Mexico Health Science Center survey* * N=1895 Could it be that the number one reason is that no one has told them why they should? Why people don’t monitor blood glucose levels? Burge MR. Lack oCare, August 2001;24:1502-1503f compliance with home blood glucose monitoring predicts hospitalization in diabetes. Diabetes.

  5. There are many reasons • Evaluate food choices • Evaluate exercise • Evaluate medication • Check for hypoglycemia It all makes perfect sense to us but………. Do the patients care? Why Monitor? Why Should We Monitor?

  6. Would they drive without these? When do we look at these the most? When we are at 0 or at 80? We need to give them reasons

  7. Do we look at the balance before and after we write a check? What about a checkbook?

  8. How do we explain why? • Everyone gets feedback on what they do. • Their check stub • How far they run • How many sit-ups • Their bowling average • Their 401k • So why not their food choices or medication? How do we explain why?

  9. Ask the patient to check before eating a meal. • Ask them to write down what they ate. • Have them check about 2 hours later. • Have them record the difference in the readings. • If the increase is greater than 30 mg/dl ask them to write down why they think it happened. Putting into action! Joslin Diabetes Center. Blood glucose monitoring, your tool for diabetes control. Available at: http://www.joslin.org/managing_your_diabetes_650.asp. Accessed March 2, 2009. 3American Diabetes Association. Getting started. Available at: http://www.diabetes.org/weightloss-and-exercise/exercise/getting-started.jsp. Accessed March 2, 2009

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