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Monitoring is an essential part of the treatment for type 2 diabetes. This includes the following:

Self-monitoring of Blood Glucose

If you are using insulin, your doctor may advise you to monitor your blood glucose level using a glucose monitoring kit. This includes a special device to obtain a drop of blood from your finger, which you then test to determine the glucose level. Your doctor will show you how to use the monitoring kit.

To obtain the drop of blood, you may use:

  • Lancet—a disposable, sharp needle-like sticking device
  • Lancet device—a spring-loaded finger sticking device

The drop of blood is applied to a chemically treated test strip. The glucose meter reads the strip and gives you a number value. Work with your doctor to decide how many times and when you should check your blood glucose levels.

Most kits provide a diary so that you can keep track of your results. If not, your doctor may be able to provide you with one. Write down your results immediately. It is easy to forget the number. Always bring your diary with you when you visit the doctor. Your glucose levels are a very important component to determining your treatment.

Special Considerations

A glucose monitor may become less accurate over time. Be sure to test your monitor for accuracy at least once a month, or anytime you suspect a problem. Check the manufacturer's directions to find out how to test your monitor.

Hemoglobin A1c (HbA1c)

Hemoglobin A1c (HbA1c) test measures the amount of glycated hemoglobin in the blood. This gives an indication of your average blood glucose level over the previous 2-3 months. The test is done in your doctor's office and requires only a blood sample. You are not required to fast before this test.

Hemoglobin is a protein in red blood cells that carries oxygen. When glucose in the blood attaches to this protein, glycated hemoglobin is formed. Red blood cells stay in the body's circulation for 2-3 months, making HbA1c a good measure of your blood glucose levels over time.

The results of HbA1c tests are given in percentages, and can be interpreted as follows:

  • Normal to less than 7%—excellent control, corresponds to blood glucose of 60-150 mg/dl (3.3-8.3 mmol/L) on average
  • Over 7% and up to 8%—good control, corresponds to blood glucose of 150-180 mg/dl (8.3-10.0 mmol/L) on average
  • Over 8% up to 10%— fair to poor control, corresponds to blood glucose of 180-240 mg/dl (10.0-13.3 mmol/L) on average
  • Over 10%—very poor control, corresponds to an average blood glucose of over 240 mg/dl (13.3 mmol/L)

Note: An HbA1c result of 6.5% or greater is diagnostic for diabetes. People without diabetes have levels lower than this.

Lowering your HbA1c can help reduce the risk of complications from diabetes, such as damage to your kidneys and eyes. However, lowering your blood sugar levels can increase your risk of developing hypoglycemia. Talk with your doctor about setting specific HbA1c goals for you. Also ask how often you should have this test done.

Ketone Testing

You may be asked to test your urine for ketones when your blood glucose levels are high or when you are sick. Ketones are produced when your body is breaking down fat, instead of carbohydrates, for energy.

Large amounts of ketones in the body can lead to a condition called ketoacidosis, which can be a potentially life-threatening condition. People with type 2 diabetes are not prone to developing ketones. But, in cases of severe hyperglycemia or infection, ketoacidosis may occur.

When testing for ketones, it is important that you follow the directions carefully and exactly. The kit provides you with individual-use chemically treated strips. Pass the strip through the stream of urine or place it in a container of urine. Compare the strip against a color chart provided to determine if ketones are present.

The best time to conduct the test is in the morning before breakfast and any time your blood glucose is over 240 mg/dL (13.3 mmol/L). Call your doctor if you have a positive result on the ketone test.

Surgery

If you have type 2 diabetes, are obese , and have complications, then you may be a candidate for bariatric surgery. Bariatric surgery may help to improve or resolve type 2 diabetes.

Regular Checkups With Specialists

Since type 2 diabetes affects several systems in your body, your primary care doctor will likely refer you to several specialists to help prevent and/or manage the complications of this disease. The specialists who may be involved in your care include the following:

  • Endocrinologist—a diabetes specialist
  • Ophthalmologist—an eye expert
    • You should have an eye exam once a year, or more frequently, as recommended by your eye specialist.
  • Surgeon—specialist in bariatric surgery
  • Podiatrist—foot care specialist
    • A podiatrist can spot problems caused by poor circulation and provide proper treatment.
  • Diabetes nurse educator—to help you learn the steps for day-to-day management of type 2 diabetes
  • Diabetes dietitian educator—a registered dietitian who is certified as a diabetes educator
    • This person can help you determine how to adjust your eating patterns to help control your diabetes.
  • Exercise physiologist—to develop a personalized exercise plan
  • Social worker, psychologist, or other mental health professional—Any of these people can help you to deal with the stresses and challenges of living with a chronic disease.
When to Contact Your Doctor

If your blood glucose levels are outside of the normal range, report this to your doctor. If this happens often, you and your doctor may need to make a change in your treatment plan. Also, if you develop any new symptoms, talk to your doctor. You may need a referral to a specialist for further care.

References:

American Diabetes Association. American Diabetes Association position statement: standards of medical care in diabetes 2010. Diabetes Care. 2010;33:S1-S99.

American Diabetes Association. Executive summary: standards of medical care in diabetes—2010. Diabetes Care. 2010;33:S4-S10.

Diabetes mellitus type 2. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 2, 2012. Accessed August 6, 2012.

Vetter ML, Cardillo S, Rickels MR, Iqbal N. Narrative review: effect of bariatric surgery on type 2 diabetes mellitus. Ann Int Med. 2009;150:94-103.

Your health care team. American Diabetes Association website. Available at: http://www.diabetes.org/living-with-diabetes/treatment-and-care/who-is-on-your-healthcare-team/your-health-care-team.html. Accessed August 6, 2012.

4/2/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Choosing wisely. EBSCO DynaMed website. Updated March 26, 2014. Accessed April 2, 2014.



Last reviewed September 2013 by Kim Carmichael, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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