Diabetes mellitus (DM), is a group of metabolic disorders that are associated with the impairment of the body to regulate blood sugar levels adequately. The international diabetes federation reports as of 2019, approximately 463 million adults (20-79 years) are living with diabetes around the globe. Among this 90 % of the patients suffers from type 2 diabetes that is a result of insulin resistance. And the rest equates for type 1 diabetes that develops due to the absolute deficiency of insulin.

Today 10.9% of the United States adult population is estimated to have diabetes with a trend suggesting the rates to continue to rise. This is due to the increase in sedentary lifestyles and unhealthy eating patterns observed throughout the country.

Individuals with diabetes, especially type 2 are at high risk of developing multi-organ system complications, such as cardiovascular diseases, gastroparesis, kidney dysfunction, and vision problems, etc.

As diabetes remains an incurable disorder, its effective control and vigilant monitoring remain the only practical solution to date. Fortunately, multiple modalities are available in the market that can safely be employed at home to monitor blood sugar levels, to access the response to treatment, and to the progression of diabetes.

When to Monitor?

Usually, the monitoring of blood glucose levels at home is recommended by clinicians as soon as the diagnosis of the disease is confirmed. The frequency of these tests depends upon the type of diabetes an individual has and the treatment plan he or she follows. However, some general indications for monitoring blood glucose levels include:

• The ideal time to check blood glucose levels is accepted to be before and after meals, especially for individuals on insulin therapy or medications that increase insulin secretion.
• More frequent monitoring should be considered when a patient adapts to a new routine, such as trying new foods, new exercises, under stress or sickness, and while switching medications.
• Patients with type two diabetes managed with lifestyle changes and dietary control may not require as frequent testing as those on insulin therapy.
• All pregnant women are tested for gestational diabetes twice in their regular follow-ups. However, only those showing elevated results or with a previous history of gestational diabetes are asked to monitor glucose levels regularly during pregnancy.

Glucose meters:

These are portable compact devices that provide an approximate concentration of glucose levels in the blood within seconds. These meters require a drop of blood, freshly obtained by pricking a fingertip with a lancet. The blood is placed on the testing strip inserted into the meter, which then quickly analyzes the sugar levels in the sample. A digitalized reading of blood glucose concentration is produced that can also be saved for future reference. Some devices can even use blood drawn from other sites of the body however, fingertip testing remains the most accurate reflection of the blood glucose levels.

Care to be taken while using a glucose meter:

• The patient should always first read and follow the instructions provided by the manufacturer with the glucose meter.
• All testing strips should be kept in the original container, as they can be damaged by air and dust. The patient should also always assure before using the strips, that they are not outdated and are compatible with the monitoring machine.
• Patients should always wash their hands before and after testing sugar levels.
• Alternate testing sites other than fingertips should not be used if the patient has a quick rise and fall in sugar levels. As the readings obtained from other sites lag behind up to 20 minutes in glucose concentration in comparison to fingertips.

Continuous Glucose Monitoring sensors (CGMS):

These FDA approved devices provide close monitoring of glucose levels in the interstitial fluid of the body throughout the day. These are connected to the body through tiny sensors that are placed under the skin into the fatty tissues where they continuously collect samples and transmit data to a receiver.

The receiver either a digital screen provided on the device, or a smartphone app, or a smartwatch displays blood glucose concentration levels after every few minutes that are the average of all the readings recorded during this period. The device can also be programmed to set an alarm off in cases where the blood sugar levels fluctuate to any extremes.

A 24-hour measurement provided by the device can also assist in adjusting insulin dosing more accurately. Multiple pieces of literature show improved glycemic control in individuals using continuous glucose monitoring. Many individuals with type 1 diabetes prefer the use of CGMS devices more than type 2 patients.

These devices are set by the user and the sensors in it can easily be worn continuously for a few days to a week, before they are needed to be changed. The most advanced type of CGM sensor can be implanted in the body to monitor glucose levels for 3 months.

Care to be taken while using a continuous glucose monitor:

• The glucose values displayed by continuous glucose monitoring are average of 5-25 minutes of reading therefore, unlike fingerstick testing, CGMS does not accurately show the current levels of blood glucose.
• The readings obtained through CGMs device are the glucose concentration in the fluid found between the cells and therefore, do not represent blood glucose levels. Patients will still need to take the fingerstick test for more accurate measurement.
• The CGMS results should be confirmed with the fingerstick glucose test when considering any acute change in therapy. Such as increasing insulin dosing or consuming carbohydrate snacks to counter hypoglycemia shown by CGMS.

Test for Monitoring Diabetes

Patients with type 2 diabetes can also benefit from testing for glycemic control with a more accurate evaluation procedure such as HbA1C. This test provides the mean blood glucose control value for the past 3 months, making it a reliable indicator to be monitored for disease progression and treatment efficacy.

Understanding your target range:

it is essential for all diabetic patients to be able to interpret their blood glucose readings. A healthcare provider should explain and introduce all related concepts and testing methods to a newly diagnosed patient. The interpretation and target values of these readings depend upon:

• patients age,
• type of diabetes,
• risk and presence of related complication,
• pregnancy status,
• pre-existing medical conditions,
• and duration of the disorder is a few factors that determine the target range of blood glucose levels in each individual.

The American Diabetes Association (ADA) provides a general recommendation of target ranges that should be tried to be achieved by patients and concerning healthcare providers :

• Between 80 and 130 milligrams per deciliter (mg/dL) or 4.4 to 7.2 millimoles per liter (mmol/L) before meals.
• Less than 180 mg/dL (10.0 mmol/L) two hours after meals.
• HBA1C levels less than 7% at all times.

Again these goals often vary from patient to patient and should be individualized. For instance, some patients might have slightly higher blood sugar goals, such as:

• Patients who are age 60 years and older,
• Patients having pre-existing medical conditions, such as heart, lung or kidney diseases,
• Patients having a reduced ability to sense low blood sugar levels (hypoglycemia unawareness).