Self-Monitoring Blood Glucose (SMBG)

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

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

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

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

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?

How often does your patient use insulin?

Which of these insulins does your patient use?

Is your patient sick or starting a steroid drug?

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

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.

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

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.

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

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.

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

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.

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

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.

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

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.

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

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.

SMBG pattern to learn the effects of various meals.

SMBG pattern to learn the effects of exercise.

• Sometimes benefit is seen 4 -8 hours later, so alternate post-exercise testing times.

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

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

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

• If on a secretagogue, check also when hypoglycemia is suspected or has occurred

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

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.

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.

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.

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF

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.

SMBG Pattern Recommendation:Download PDF

ALL SMBG Patterns:Download PDF