Interview

Dr Ajay Kumar brings to you answers to the questions on "Importance Of Monitoring Blood Glucose"

 

Q1. What is the importance given to monitoring blood glucose in clinical practice?

Ans. Importance of monitoring blood glucose -

• Ensures adequate metabolic control
• Prevents serious acute complications, (both hypoglycemic and hyperglycemic emergencies), by prompt rectification of the loss of metabolic control
• Decreases risk of micro vascular and to some extent macro vascular complication, by ensuring good glycemic control
• Helps in fine tuning of dosage adjustment
• Provides great flexibility in daily life
• Involves patients and self management process and thereby improves compliance

Q2. Which is the preferred way monitoring glucose?

Ans. The preferred way of monitoring glucose -

Type 1 Diabetes: SMBG (Self measurement of blood glucose)

Type 2 Diabetes: Appropriate method of monitoring in type 2 diabetes is yet to be defined through adequate clinical trials. However, if logistics permit, then SMBG should be ideal.

In practice, non-insulin treated type 2 diabetics can perform self-measurement of urinary glucose. Patients with altered renal threshold should not rely on urinary glucose measurements. Glycosuria should initially be determined after meals three times a day. Once glycemic control has been achieved, the frequency of monitoring can be reduced to 2-3 times weekly.

Insulin treated type 2 diabetics should monitor their urinary glucose before meals. Patients are instructed to void approximately 30-60 minutes before a meal and then immediately before meal. In younger patients, SMBG is preferable. However if logistics do not permit, then urinary glucose measurements must be done.

Q3. How often do you recommend a patient to use a blood glucose-monitoring device on a regular basis?

Ans. Approximately 10-20 percent of my patients are advised for regular blood glucose monitoring. Important groups are:

• GDM patients
• Type 1 diabetics
• Young type 2 diabetics on insulin therapy
• Type 2 diabetics, on OHA with very brittle control
• Type 2 diabetics with past history of hospital admissions with hypoglycemic or hyperglycemic emergencies

Q4. How will you judge the accuracy of a blood glucose-monitoring device?

Ans.  Accuracy of the device can be judged by :

• Comparability with standard laboratory measurements
• Reproducibility

Q5. When would you ask a patient to estimate the ketone levels?

Ans. Euglycaemia: I generally ask the patient for estimation of ketone levels -

• Any case of suspected hyperglycemic emergencies, like diabetic keto-acidosis or hyperosmolar non-ketotic diabetic state (HNKS).
• During management of DKA and HNKS
• During peri-operative management of diabetic patients undergoing emergency surgery

Q6. What are the most common factors/causes, which lead to diabetic ketoacidosis?

Ans. Factors leading to diabetic ketoacidosis -

• Infections: Bacterial, viral or protozoal
• Erratic metabolic control
• Acute myocardial infarction
• Stroke
• Newly diagnosed type 1 diabetes

Q7. What mode of therapy do you follow to treat diabetic ketoacidosis and prevent recurrence?

Ans. Diabetic ketoacidosis: treatment and prevention

Principles of management are:

• Frequent monitoring of blood glucose, electrolytes., blood gases, ketones etc
• Rehydration
• Rapid acting insulin infusion
• Correction of electrolyte imbalance
• Correction of acid-base abnormalities
• Treatment of precipitating factor
• Prevention of complications

To prevent recurrence, patient’s education is most important. Patients must learn:

• Self monitoring of blood glucose
• Symptoms of impending hyperglycemic emergencies
• Proper dietary modification and exercise training
• Adjustment of diet and drugs, if intensive exercise activities are planned
• Prompt treatment of any intercurrent infection

Q8. What lifestyle modifications would you advice these patients?

Ans. Lifestyle modification

• Diet
• Exercise
• Self monitoring of blood glucose
• Cessation of smoking and alcohol
• Yogic practices

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