Appendix 4

Self-Monitoring of Blood Glucose (SMBG) Recommendation Tool for Healthcare 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 healthcare team must be willing to review and act upon the SMBG results in addition to the A1C results.
 

 A. REGULAR SMBG is required if the person with diabetes is:
SITUATION SMBG RECOMMENDATION
Using multiple daily injections of insulin (≥4 times per day)
Using an insulin pump
SMBG ≥4 times per day
(see page 2 – QID – [basal-bolus/MDI])
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 lifestyle 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 lifestyle and oral 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:
Screen for diabetes complications annually or as indicated
Is treated only with lifestyle and is meeting glycemic targets
Has pre-diabetes
Additional CDA resources
• Lows and highs: blood glucose levels
• Managing your blood glucose
• Monitoring for Glycemic Control. Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes. 2008;32(suppl 1):S32-S36.
• Self-Monitoring of Blood Glucose in People with Type 2 Diabetes: Canadian Diabetes Association Briefing Document for Healthcare Providers. Can J Diabetes. 2011;35:317-319.

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
 
QID (basal-bolus/MDI) – typically given as a rapid-acting analog or regular insulin (bolus) before each meal and NPH or long-acting analog (basal) typically given at bedtime. 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
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:
Stable, Focus on
post-meal 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
 
MDI = multiple daily injections
No funding sources were used by the CDA for the development or launch of this document on SMBG.
 

Click to view printable and saveable pdf


*The Canadian Diabetes Association is the registered owner of the name Diabetes Canada. All content on guidelines.diabetes.ca, CPG Apps and in our online store remains exactly the same. For questions, contact communication@diabetes.ca.