Scientifically control blood sugar: how can diabetic patients achieve accurate self-monitoring?

Author: Liu Xiangyi, Professor of Beijing Tongren Hospital, Capital Medical University

Reviewer: Wu Xueyan, Chief Physician, Peking Union Medical College Hospital

Diabetes is a chronic disease characterized by long-term high blood sugar levels that lead to damage to body tissues, especially the eyes, kidneys, heart, blood vessels and nervous system. Therefore, the health management of diabetic patients is not limited to monitoring blood sugar levels, but also requires comprehensive consideration of other related indicators.

The diagnosis of diabetes cannot be determined by a single abnormal blood sugar level, but requires a comprehensive judgment based on multiple criteria. First, fasting blood sugar ≥ 7.0mmol/L, blood sugar ≥ 11.1mmol/L two hours after a meal, or symptoms such as polydipsia, polyphagia, polyuria, and weight loss with random blood sugar ≥ 11.1mmol/L, these conditions meet the diagnostic criteria for diabetes.

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In addition, the oral glucose tolerance test (OGTT) is also widely used in the diagnosis of prediabetes and diabetes. This test evaluates the individual's tolerance to glucose by giving the subject a certain dose of glucose load and observing the blood sugar level in the body. Under normal circumstances, fasting blood sugar should be lower than 6.1mmol/L, and blood sugar two hours after a meal should not exceed 7.8mmol/L. If it exceeds this range, it may indicate the risk of impaired glucose tolerance or diabetes.

For diabetic patients, in addition to daily monitoring of blood sugar levels, they also need to pay attention to other important metabolic indicators such as blood lipids and blood pressure. Blood lipid tests usually include four items: total cholesterol, triglycerides, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol. Among them, low-density lipoprotein cholesterol is considered one of the important risk factors for cardiovascular disease, so it occupies a core position in diabetes management. Hypertension is one of the common complications of diabetes and imposes an additional burden on the cardiovascular system, so regular blood pressure measurement is important for preventing complications. In addition, fundus examination and urine microalbumin detection should not be ignored. The former helps to detect retinopathy early, and the latter is an important marker for evaluating kidney function. Both can effectively warn of microvascular complications that may be caused by diabetes.

Regarding the frequency of blood sugar monitoring, it depends on the specific situation of the patient. For newly diagnosed patients or those with poor blood sugar control, it is recommended to monitor fasting blood sugar, blood sugar before and after meals, and blood sugar before bedtime daily so as to adjust the treatment plan in time. For patients whose blood sugar has been effectively controlled, such as glycated hemoglobin maintained below 7%, the number of monitoring times can be appropriately reduced to once a week or every few days. It is worth noting that it is particularly important to monitor blood sugar before bedtime, because the occurrence of nocturnal hypoglycemia not only affects sleep quality, but may even be life-threatening. Therefore, maintaining a reasonable monitoring frequency and adjusting the treatment plan in a timely manner according to the monitoring results are the keys to achieving good blood sugar control.

Self-testing blood sugar at home is an important part of daily management for patients with diabetes. However, due to technical differences between home blood glucose meters and those used in hospitals, there may be deviations in the blood sugar values ​​measured by the two. Home monitoring is acceptable for routine treatment monitoring, but it is recommended to come to the hospital regularly to test fasting and postprandial blood sugar levels during medication adjustment.

In order to improve the accuracy of self-testing blood sugar, patients need to pay attention to the following points: first, ensure that the blood glucose meter is in good working condition and calibrate it regularly; second, properly store the test strips to avoid high or low temperature environments that may cause the chemical components to become ineffective; finally, follow the correct blood collection process, that is, discard the first drop of blood first, and then evenly apply the second drop of blood on the test strip. Only when the above conditions are met can a more accurate blood glucose reading be obtained, thus better guiding blood glucose management in daily life.

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