Appendix 5

Self-Monitoring of Blood Glucose (SMBG) Recommendation Tool for Health-Care Providers

Part A:

Basic SMBG requirements (must be met)
The person with diabetes (or a family member/caregiver) must have the knowledge and skills to use a home blood glucose monitor and to record the results in an organized fashion.
The person with diabetes and/or members of the health-care team must be willing to review and act upon the SMBG results in addition to the glycated hemoglobin (A1C) results.
 

 A. REGULAR SMBG is required if the person with diabetes is:
SITUATION SMBG RECOMMENDATION
Using basal-bolus insulin injection therapy of insulin (≥4 times per day)
Using CSII (insulin pump)
SMBG ≥4 times per day
(see page 2 – 4 times per day – [basal-bolus])
Using insulin <4 times per day SMBG at least as often as insulin is being given
(see page 2 – premixed or basal insulin only)
Pregnant (or planning a pregnancy), whether using insulin or not
Hospitalized or acutely ill
SMBG individualized and may involve SMBG ≥4 times per day
Starting a new medication known to cause hyperglycemia (e.g. steroids)
Experiencing an illness known to cause hyperglycemia (e.g. infection)
SMBG individualized and may involve SMBG ≥2 times per day


 B. INCREASED FREQUENCY OF SMBG may be required if the person with diabetes is:
SITUATION SMBG RECOMMENDATION
Using drugs known to cause hypoglycemia
(e.g. sulfonylureas, meglitinides)
SMBG at times when symptoms of hypoglycemia occur or at times when hypoglycemia has previously occurred
Has an occupation that requires strict avoidance of hypoglycemia SMBG as often as is required by employer
Not meeting glycemic targets SMBG ≥2 times per day, to assist in healthy behaviour interventions and/or medication changes until such time as glycemic targets are met
Newly diagnosed with diabetes (<6 months) SMBG ≥1 time per day (at different times of day) to learn the effects of various meals, exercise and/or medications on blood glucose
Treated with healthy behaviour interventions and noninsulin antihyperglycemic agents and is meeting glycemic targets Some people with diabetes might benefit from very infrequent checking (SMBG once or twice per week) to ensure that glycemic targets are being met between A1C tests


 C. DAILY SMBG is not USUALLY required if the person with diabetes:
Is treated only with healthy behaviour interventions and is meeting glycemic targets
Has prediabetes

Part B:

Suggested SMBG Patterns for Patients Using Insulin
Basal Insulin Only – NPH or long-acting insulin analog, 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 throughout the day.
  BREAKFAST LUNCH SUPPER BED-
TIME
NIGHT
  before after before after before after    
Insulin             NPH/
long
(basal)
 
SMBG
pattern
SMBG
test
             
Adjust-
ment
Basal insulin
↑ if BG high
↓ if BG low
             
Premixed – 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.
  BREAKFAST LUNCH SUPPER BED-
TIME
NIGHT
  before after before after before after    
Insulin pre-
test
      pre-
test
     
SMBG pattern 1:
Starting
SMBG
test
  SMBG
test
  SMBG
test
  SMBG
test
 
SMBG pattern 2:
Stable
SMBG
test
      SMBG
test
     
Alternat-
ing daily
    SMBG
test
      SMBG
test
 
Adjust-
ment
Pre-supper insulin
↑if BG high
↓if BG low
Pre-breakfast insulin
↑if BG high
↓if BG low
Pre-breakfast insulin
↑if BG high
↓if BG low
Pre-supper insulin
↑if BG high
↓if BG low
 
Basal-bolus injection therapy or CSII – typically given as a rapid-acting analog or regular insulin (bolus) before each meal and NPH or long-acting analogue (basal) typically given at bedtime or as rapid-acting insulin pump. SMBG should be QID, pre-meal and bedtime, in order to assess previous dose and to adjust next dose. Some patients find that post-prandial checking can also be helpful.
  BREAKFAST LUNCH SUPPER BED-
TIME
NIGHT
  before after before after before after    
Insulin rapid/
(bolus)
  rapid/
(bolus)
  rapid/
(bolus)
  NPH/
long-
acting
 
SMBG pattern 1:
Starting or Stable
SMBG
test
  SMBG
test
  SMBG
test
  SMBG
test
 
SMBG pattern 2:
Stable, Focus on
postmeal BG
SMBG
test
SMBG
test
  SMBG
test
  SMBG
test
   
SMBG pattern 3:
Intensive
manage-
ment
SMBG
test
SMBG
test
SMBG
test
SMBG
test
SMBG
test
SMBG
test
SMBG
test
SMBG
test
Adjust-
ment
Basal insulin
↑if BG high
↓if BG low
Pre-breakfast insulin
↑if BG high
↓if BG low
Pre-lunch insulin
↑if BG high
↓if BG low
Pre-supper insulin
↑if BG high
↓if BG low
Basal insulin
↓if BG low
 
BG, blood glucose; CSII, continuous subcutaneous insulin infusion; SMBG, self-monitoring of blood glucose
 

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