Diabetes

Treatment and Management:
Blood Glucose Monitoring

At-Home Glucose Monitoring
Glycosylated Hemoglobin Monitoring

At-Home Glucose Monitoring
If you are a person with diabetes, testing blood glucose at home will give you immediate feedback about how well treatment is working and allow you to make needed adjustments. Home glucose monitoring involves the use of a glucose meter, which measures the amount of glucose in a small drop of blood.

Many different types of meters are on the market. Your diabetes educator can help you choose the meter that is best for you.

When to Test Your Blood Glucose
Knowing what your blood glucose level is as soon as you wake up in the morning (before eating or medications), before meals, and at bedtime is helpful. On occasion, it may also help to know what your blood glucose level is one to two hours after a meal.

A typical testing schedule
Your doctor or diabetes educator can help you decide what schedule of testing is best for you. You should also test your blood glucose:

• When you start or change your exercise program. Test the glucose level before you exercise and about one hour afterward. By comparing the two readings, you will be able to tell if the exercise has lowered your blood glucose too much.
• Feel the symptoms of low blood glucose. These symptoms include shakiness, headache, rapid pulse, sweating, and hunger. See UPMC's patient education sheet Short Term Problems (pdf).
• More frequently when you are sick.

Intensive therapy
Intensive therapy consists of checking blood glucose frequently during the day and adjusting the insulin dose based on the glucose levels. This system can keep diabetes under tight control and help reduce the risk of complications. Although this method takes a lot of effort, many people find it worthwhile. If you are interested in intensive insulin therapy, talk to your doctor.

Recording Glucose Measurements
Keep a record of your blood glucose levels. Also record changes in your routines. This log will help you and the rest of your diabetes team see how exercise, food, and medications affect your blood glucose.

For more information about monitoring glucose levels, see the Testing Your Blood Glucose (pdf) patient education sheet.

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A1C (Glycosylated Hemoglobin) Monitoring

	The glycosylated hemoglobin level (A1C) reflects the "average" blood sugar over a three-month period. Blood sugar molecules attach to the red blood cells. When the sugar level is high, an abnormally high number of sugar molecules attach to these blood cells. This raises the A1C level, or the overall average blood glucose.

Sugar (glucose) in the blood attaches to hemoglobin, a part of the red blood cell. Hemoglobin with glucose attached is called glycosylated hemoglobin (HbA1c). The more sugar in the blood, the greater the number of glycosylated hemoglobin cells. Once hemoglobin has become glycosylated, it stays that way for the life of the red cell it is a part of — that is, for about 120 days.

A glycosylated hemoglobin test is a blood test, done by a doctor, that measures the average blood glucose level for the past three months. By checking the percentage of hemoglobin with sugar attached, the doctor can determine how well diabetes is being controlled.

Your doctor should check your glycosylated hemoglobin level at least twice a year. The goal is to keep the percentage of glycosylated hemoglobin less than 7 percent (see table below). Discuss your individual goals with your physician or diabetes educator.