What type of diabetes does your patient have?
Type 1 diabetes
Type 2 diabetes
Gestational diabetes mellitus (GDM)
Prediabetes
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®)
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.
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Breakfast |
Lunch |
Supper |
Bedtime |
Night |
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before |
after |
before |
after |
before |
after |
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Insulin |
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NPH/long
(basal) |
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SMBG
pattern |
SMBG
test |
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Adjustment |
Basal
insulin
↑ if BG hi
↓ if BG low |
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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.
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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.
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Basal insulin may be given in combination with secretagogue, non-secretagogue or injectable (GLP-1 analogue) medications.
|
Breakfast |
Lunch |
Supper |
Bedtime |
Night |
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before |
after |
before |
after |
before |
after |
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Insulin |
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NPH/long
(basal) |
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SMBG
pattern: |
SMBG
test |
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SMBG
test |
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Alternating
daily |
SMBG
test |
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SMBG
test |
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Adjustment |
Bedtime
insulin
↑ if BG hi
↓ if BG low |
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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.
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SMBG QID until glycemic targets are met.
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SMBG BID (alternating times) is usually sufficient once glycemic targets are met.
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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 |
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before |
after |
before |
after |
before |
after |
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Insulin |
Premix /
NPH |
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Premix /
NPH |
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SMBG
pattern 1:
Starting |
SMBG
test |
|
SMBG
test |
|
SMBG
test |
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SMBG
test |
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SMBG
pattern 2: |
SMBG
test |
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SMBG
test |
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Stable
alternating
daily |
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SMBG
test |
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SMBG
test |
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Adjustment |
Pre-supper
insulin
↑ if BG hi
↓ if BG low |
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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.
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In the example shown, the bolus insulin is given at supper but could be given at breakfast or lunch.
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The bolus insulin is typically given with the largest meal or the meal with the highest post-meal BG.
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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 |
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before |
after |
before |
after |
before |
after |
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Insulin |
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Rapid /
regular
(bolus) |
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NPH /
long
(basal) |
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SMBG
pattern 1:
Starting |
SMBG
test |
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SMBG
test |
SMBG
test |
SMBG
test |
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SMBG
pattern 2: |
SMBG
test |
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SMBG
test |
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Stable
alternating
daily |
SMBG
test |
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SMBG
test |
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Adjustment |
Basal
insulin
↑ if BG hi
↓ if BG low |
|
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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 |
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before |
after |
before |
after |
before |
after |
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Insulin |
Rapid /
regular
(bolus) |
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Rapid /
regular
(bolus) |
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Rapid /
regular
(bolus) |
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NPH /
long
(basal) |
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SMBG
pattern 1:
Starting
or Stable |
SMBG
test |
|
SMBG
test |
|
SMBG
test |
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SMBG
test |
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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 |
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before |
after |
before |
after |
before |
after |
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Insulin |
Rapid /
(bolus) |
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Rapid /
(bolus) |
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Rapid /
(bolus) |
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rapid (basal) |
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SMBG
pattern 1:
Starting
or Stable |
SMBG
test |
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SMBG
test |
|
SMBG
test |
|
SMBG
test |
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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 |
|
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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.
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Breakfast |
Lunch |
Supper |
Bedtime |
Night |
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before |
after |
before |
after |
before |
after |
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Sunday |
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Monday |
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Tuesday |
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Wednesday |
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Thursday |
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Friday |
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Saturday |
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SMBG pattern to learn the effects of various meals.
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Breakfast |
Lunch |
Supper |
Bedtime |
Night |
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before |
after |
before |
after |
before |
after |
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Sunday |
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Monday |
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Tuesday |
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Wednesday |
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Thursday |
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Friday |
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Saturday |
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SMBG pattern to learn the effects of exercise.
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Sometimes benefit is seen 4 -8 hours later, so alternate post-exercise testing times.
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Breakfast |
Lunch |
Supper |
Bedtime |
Night |
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before |
after |
before |
after |
before |
after |
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Sunday |
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Exercise |
TEST |
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Monday |
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Tuesday |
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Wednesday |
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Thursday |
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Exercise |
TEST |
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Friday |
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Saturday |
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SMBG to get a snapshot of blood glucose levels throughout the day, on one day of the week, which is a typical day.
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Breakfast |
Lunch |
Supper |
Bedtime |
Night |
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before |
after |
before |
after |
before |
after |
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Sunday |
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Monday |
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Tuesday |
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Wednesday |
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Thursday |
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Friday |
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Saturday |
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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
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Breakfast |
Lunch |
Supper |
Bedtime |
Night |
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before |
after |
before |
after |
before |
after |
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Sunday |
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Monday |
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Tuesday |
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Wednesday |
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Thursday |
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Friday |
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Saturday |
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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 |
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before |
after |
before |
after |
before |
after |
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Sunday |
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Monday |
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Tuesday |
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Wednesday |
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Thursday |
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Friday |
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Saturday |
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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.
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Breakfast |
Lunch |
Supper |
Bedtime |
Night |
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before |
after |
before |
after |
before |
after |
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Sunday |
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Monday |
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Tuesday |
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Wednesday |
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Thursday |
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Friday |
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Saturday |
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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.
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Breakfast |
Lunch |
Supper |
Bedtime |
Night |
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before |
after |
before |
after |
before |
after |
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Sunday |
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Monday |
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Tuesday |
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Wednesday |
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Thursday |
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Friday |
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Saturday |
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Sunday |
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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 |
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before |
after |
before |
after |
before |
after |
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Sunday |
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Monday |
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Tuesday |
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Wednesday |
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Thursday |
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Friday |
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Saturday |
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Breakfast |
Lunch |
Supper |
Bedtime |
Night |
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before |
after |
before |
after |
before |
after |
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Sunday |
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Monday |
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Tuesday |
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Wednesday |
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Thursday |
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Friday |
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Saturday |
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SMBG Pattern Recommendation:Download PDF
ALL SMBG Patterns:Download PDF