Type 1 Diabetes

Home Management

Monitoring Glucose (Blood Sugar) Levels

Both low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia) are of concern for patients who take insulin. It is important, therefore, to carefully monitor blood glucose levels. In general, patients with type 1 diabetes need to take readings four or more times a day. Patients should aim for the following measurements:

• Pre-meal glucose levels of 70 - 130 mg/dL
• Post-meal glucose levels of less than 180 mg/dL

Different goals may be required for specific individuals, including pregnant women, very old and very young people, and those with accompanying serious medical conditions.

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Finger-Prick Test. A typical blood sugar test includes the following:

• A drop of blood is obtained by pricking the finger.
• The blood is then applied to a chemically treated strip.
• Monitors read and provide results.

Home monitors are about 10 - 15% less accurate than laboratory monitors, and many do not meet the standards of the American Diabetes Association. Most doctors believe, however, that they are accurate enough to indicate when blood sugar is too low.

Some simple procedures may improve accuracy:

• Testing the meter once a month.
• Recalibrating it whenever a new packet of strips is used.
• Using fresh strips; outdated strips may not provide accurate results.
• Keeping the meter clean.
• Periodically comparing the meter results with the results from a laboratory.

Continuous Glucose Monitoring Systems

Continuous glucose monitoring systems (CGMs) use a needle-like sensor inserted under the skin of the abdomen to monitor glucose levels every 5 minutes. Depending on the system, CMGs measure glucose levels for 3- 7 days and sound an alarm if glucose levels are too high or low. These devices are used in addition to traditional fingerstick test kits and glucose meters but do not replace them.

Urine Tests

Urine tests are useful for detecting the presence of ketones. These tests should always be performed during illness or stressful situations, when diabetes is likely to go out of control. The patient should also undergo yearly urine tests for microalbuminuria (small amounts of protein in the urine), a risk factor for future kidney disease.

Preventing Hypoglycemia

The following tips may help avoid hypoglycemia or prepare for attacks.

• Bedtime snacks are advisable if blood glucose levels are below 180 mg/dL (10 mmol/L). Protein snacks may be best.
• Some research has suggested that children (particularly thin children) are at higher risk for hypoglycemia because the injection goes into muscle tissue. Pinching the skin so that only fat (and not muscle) tissue is gathered or using shorter needles may help.
• Various insulin regimens are available that can reduce the risk. For example, taking a fast-acting insulin (insulin lispro) before the evening meal may be particularly helpful in preventing hypoglycemia at bedtime or during the night.
• Patients who intensively control their blood sugar should monitor blood levels as often as possible, four times or more per day. This is particularly important for patients with hypoglycemia unawareness.
• In adults, it is particularly critical to monitor blood glucose levels before driving, when hypoglycemia can be very hazardous.
• Patients who are at risk for hypoglycemia should always carry hard candy, juice, sugar packets, or commercially available glucose substitutes.
• Patients at high risk for severe hypoglycemia, and their family members, should consider having on hand a glucagon emergency kit. The kit is available by prescription and contains an injection of glucagon, a hormone that helps to quickly raise blood glucose levels.