Self-Monitoring Blood Glucose (SMBG)

Frequency & Pattern Tool

Use this calculator to determine how frequently your patient should be checking their blood glucose, with some suggested patterns for monitoring.

Reset

STEP 1: Frequency

What type of diabetes does your patient have?

Type 1 diabetes
Type 2 diabetes
Gestational diabetes mellitus (GDM)
Prediabetes

Is your patient with type 1 diabetes on an insulin pump?

Yes No

Is your patient with type 1 diabetes taking 4 or more doses of insulin daily?

Yes No

Is your patient's A1C to target (typically ≤7.0%)?

Yes No

What drug(s) does your patient take for their type 2 diabetes?

Insulin
Insulin secretagogue1
Other2
None

1: Examples include: Glicazide (Diamicron®), Glimepiride (Amaryl®), Glyburide (DiaBeta®), Nateglinide (Starlix®), Repaglinide (Gluconorm®)
2: Examples include: Acarbose (Glucobay®), Exenatide (Byetta®), Linagliptin (Trajenta™), Liraglutide (Victoza®), Long Acting Metformin (Glumetza®), Metformin (Glucophage®), Saxagliptin (Onglyza®), Sitagliptin (Januvia®)

Is your patient on an insulin pump?

Yes No

How often does your patient use insulin?

Once daily
Twice daily
Four times daily

Which of these insulins does your patient use?

Premix insulin twice daily
NPH twice daily
Rapid/regular once daily and NPH/long acting once daily

Is your patient sick or starting a steroid drug?

Yes No

Has your patient recently been diagnosed with diabetes (<6 months)?

Yes No

SMBG Frequency Recommendation:

SMBG 4 or more times per day.

STEP 2: Pattern

Please complete step 1
 

Click to Reveal SMBG Pattern Recommendation

SMBG Pattern Recommendation:

Basal Insulin Only (To Target)

NPH or long-acting insulin analogue, typically given at bedtime.
SMBG at least as often as insulin is being given.

  • Optional, less frequent SMBG can be done at other times of day to ensure glycemic stability through the day, or to detect hypoglycemia caused by secretagogue, if applicable.
  • Basal insulin may be given in combination with secretagogue, non-secretagogue or injectable (GLP-1 analogue) medications.
  Breakfast Lunch Supper Bedtime Night
  before after before after before after    
 
Insulin             NPH/long
(basal)
 
 
SMBG
pattern
SMBG
test
             
 
Adjustment Basal
insulin
↑ if BG hi
↓ if BG low
             

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

Basal Insulin Only (Not To Target)

NPH or long-acting insulin analogue, typically given at bedtime.
SMBG ≥2 times per day, to assist in lifestyle and/or medication changes until glycemic targets are met.

  • Optional, less frequent SMBG can be done at other times of day to detect hypoglycemia caused by secretagogue, if applicable.
  • If initiating basal insulin, focus should be mostly on the before breakfast SMBG test; the before supper and bedtime SMBG testing is less important / optional.
  • If patient is on basal insulin, before breakfast SMBG test is to target but A1C is not to target, focus should be more on the before supper and bedtime SMBG testing.
  • Basal insulin may be given in combination with secretagogue, non-secretagogue or injectable (GLP-1 analogue) medications.
  Breakfast Lunch Supper Bedtime Night
  before after before after before after    
 
Insulin             NPH/long
(basal)
 
 
SMBG
pattern:
SMBG
test
      SMBG
test
     
Alternating
daily
SMBG
test
          SMBG
test
 
 
Adjustment Bedtime
insulin
↑ if BG hi
↓ if BG low
             

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

Premixed Insulin (or NPH twice daily)

Insulin doses are typically given pre-breakfast and pre-supper.
SMBG at least as often as insulin is being given.

  • SMBG QID until glycemic targets are met.
  • SMBG BID (alternating times) is usually sufficient once glycemic targets are met.
  • Premixed insulin may be given in combination with non-secretagogue or injectable (GLP-1 analogue) medications.
  • Premixed insulin would not typically be used in combination with secretagogue medications.
  Breakfast Lunch Supper Bedtime Night
  before after before after before after    
 
Insulin Premix /
NPH
      Premix /
NPH
     
 
SMBG
pattern 1:
Starting
SMBG
test
  SMBG
test
  SMBG
test
  SMBG
test
 
SMBG
pattern 2:
SMBG
test
      SMBG
test
     
Stable
alternating
daily
    SMBG
test
      SMBG
test
 
 
Adjustment Pre-supper
insulin
↑ if BG hi
↓ if BG low
  Pre-
breakfast
insulin
↑ if BG hi
↓ if BG low
  Pre-
breakfast
insulin
↑ if BG hi
↓ if BG low
  Pre-supper
insulin
↑ if BG hi
↓ if BG low
 

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

Basal Plus

Insulin doses are typically given as a rapid-acting analogue or regular insulin (bolus) before one meal plus NPH or long-acting insulin analogue given at bedtime.
SMBG at least as often as insulin is being given.

  • In the example shown, the bolus insulin is given at supper but could be given at breakfast or lunch.
  • The bolus insulin is typically given with the largest meal or the meal with the highest post-meal BG.
  • Basal plus NPH or a long-acting insulin may be given in combination with secretagogue (at a different time than bolus insulin), non-secretagogue or injectable (GLP-1 analogue) medications.
  • SMBG QID until glycemic targets are met.
  • SMBG BID (alternating times) is usually sufficient once glycemic targets are met.
  Breakfast Lunch Supper Bedtime Night
  before after before after before after    
 
Insulin         Rapid /
regular
(bolus)
  NPH /
long
(basal)
 
 
SMBG
pattern 1:
Starting
SMBG
test
      SMBG
test
SMBG
test
SMBG
test
 
SMBG
pattern 2:
SMBG
test
        SMBG
test
   
Stable
alternating
daily
SMBG
test
          SMBG
test
 
 
Adjustment Basal
insulin
↑ if BG hi
↓ if BG low
        Pre-supper bolus
insulin
↑ if BG hi
↓ if BG low
 

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

QID (Basal-Bolus / Multiple Daily Injections [MDI])

Insulin doses are typically given as a rapid-acting analogue or regular insulin (bolus) before each meal, and NPH or long-acting analogue (basal) typically given at bedtime.
SMBG at least as often as insulin is being given.

  • SMBG should be QID, pre-meal and bedtime, in order to assess previous dose, and to adjust next dose. Some patients find post-prandial checking can also be helpful.
  • For people with type 2 diabetes, basal-bolus / MDI may be given in combination with non-secretagogue or injectable (GLP-1 analogue) medications.
  • Basal-bolus / MDI would not typically be used in combination with secretagogue medications.
  Breakfast Lunch Supper Bedtime Night
  before after before after before after    
 
Insulin Rapid /
regular
(bolus)
  Rapid /
regular
(bolus)
  Rapid /
regular
(bolus)
  NPH /
long
(basal)
 
 
SMBG
pattern 1:
Starting
or Stable
SMBG
test
  SMBG
test
  SMBG
test
  SMBG
test
 
 
SMBG
pattern 2:
Intensive
management
BG
SMBG
test
SMBG
test
SMBG
test
SMBG
test
SMBG
test
SMBG
test
SMBG
test
SMBG
test
 
 
Adjustment Basal
insulin
↑ if BG hi
↓ if BG low
Pre-breakfast
bolus insulin
↑ if BG hi
↓ if BG low
Pre-lunch
bolus insulin
↑ if BG hi
↓ if BG low
Pre-supper bolus
insulin
↑ if BG hi
↓ if BG low
Basal
insulin
↑ if BG hi
↓ if BG low

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

Insulin pump

Insulin doses are typically given as a rapid-acting analogue (bolus) before each meal and a continuous rapid-acting insulin analogue throughout the day and night.
SMBG at least as often as insulin is being given.

  • SMBG should be QID, pre-meal and bedtime in order to assess previous dose and to adjust next dose. Some patients find post-prandial checking can also be helpful.
  • For people with type 2 diabetes, insulin pump therapy may be given in combination with non-secretagogue or injectable (GLP-1 analogue) medications.
  • Insulin pump therapy would not typically be used in combination with secretagogue medications.
  Breakfast Lunch Supper Bedtime Night
  before after before after before after    
 
Insulin Rapid /
(bolus)
  Rapid /
(bolus)
  Rapid /
(bolus)
     
  rapid (basal)
 
SMBG
pattern 1:
Starting
or Stable
SMBG
test
  SMBG
test
  SMBG
test
  SMBG
test
 
 
SMBG
pattern 2:
Intensive
management
SMBG
test
SMBG
test
SMBG
test
SMBG
test
SMBG
test
SMBG
test
SMBG
test
SMBG
test
 
Adjustment Basal
insulin
(night)
↑ if BG hi
↓ if BG low
Pre-breakfast
bolus insulin
↑ if BG hi
↓ if BG low
Pre-lunch bolus
insulin
↑ if BG hi
↓ if BG low
Pre-supper bolus
insulin
↑ if BG hi
↓ if BG low
Basal
insulin
(night)
↑ if BG hi
↓ if BG low
    or adjust basal insulin (day)  

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

Diagnosis of type 2 diabetes in the past 6 months or not meeting glycemic targets

Check ≥1 time per day, on average, and at different times of day to learn the effects of various meals, exercise and/or medications on blood glucose.

Please pick one of the following SMBG patterns below, considering the clinical context as wel as patient preference.

SMBG basic pattern.

  Breakfast Lunch Supper Bedtime Night
  before after before after before after    
Sunday                
Monday                
Tuesday                
Wednesday                
Thursday                
Friday                
Saturday                

SMBG pattern to learn the effects of various meals.

  Breakfast Lunch Supper Bedtime Night
  before after before after before after    
Sunday                
Monday                
Tuesday                
Wednesday                
Thursday                
Friday                
Saturday                

SMBG pattern to learn the effects of exercise.

  • Sometimes benefit is seen 4 -8 hours later, so alternate post-exercise testing times.
  Breakfast Lunch Supper Bedtime Night
  before after before after before after    
Sunday       Exercise TEST      
Monday                
Tuesday                
Wednesday                
Thursday           Exercise TEST  
Friday                
Saturday                

SMBG to get a snapshot of blood glucose levels throughout the day, on one day of the week, which is a typical day.

  Breakfast Lunch Supper Bedtime Night
  before after before after before after    
Sunday                
Monday                
Tuesday                
Wednesday                
Thursday                
Friday                
Saturday                

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

Type 2 diabetes treated with lifestyle and oral agents AND is meeting glycemic targets.

Infrequent checking recommended. Check 1 to 2 times per week.

  • If on a secretagogue, check also when hypoglycemia is suspected or has occurred
  Breakfast Lunch Supper Bedtime Night
  before after before after before after    
Sunday                
Monday                
Tuesday                
Wednesday                
Thursday                
Friday                
Saturday                

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

Patient is sick or starting a steroid medication.

Check ≥2 times per day, to assist in lifestyle and/or medication changes until glycemic targets are met.

  • If on a secretagogue, check also when hypoglycaemia occurs and/or has occurred.

Please pick one of the following SMBG patterns below, considering the clinical context as wel as patient preference.

  Breakfast Lunch Supper Bedtime Night
  before after before after before after    
Sunday                
Monday                
Tuesday                
Wednesday                
Thursday                
Friday                
Saturday                

 

Check ≥2 times per day, to assist in lifestyle and/or medication changes until glycemic targets are met.

  • If on a secretagogue, check also when hypoglycaemia occurs and/or has occurred.
  Breakfast Lunch Supper Bedtime Night
  before after before after before after    
Sunday                
Monday                
Tuesday                
Wednesday                
Thursday                
Friday                
Saturday                

 

Check ≥2 times per day, to assist in lifestyle and/or medication changes until glycemic targets are met.

  • If on a secretagogue, check also when hypoglycaemia occurs and/or has occurred.
  Breakfast Lunch Supper Bedtime Night
  before after before after before after    
Sunday                
Monday                
Tuesday                
Wednesday                
Thursday                
Friday                
Saturday                
Sunday                

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

Gestational diabetes

SMBG needs to be individualized and may involve testing ≥4 times per day.

Please pick one of the following SMBG patterns below, considering the clinical context as wel as patient preference.

  Breakfast Lunch Supper Bedtime Night
  before after before after before after    
Sunday                
Monday                
Tuesday                
Wednesday                
Thursday                
Friday                
Saturday                

 

  Breakfast Lunch Supper Bedtime Night
  before after before after before after    
Sunday                
Monday                
Tuesday                
Wednesday                
Thursday                
Friday                
Saturday                

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

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