Diabetic Home Care and Monitoring

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Diabetic Home Care and Monitoring

Medical Author: Ruchi Mathur, MD, FRCP(C)
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

What is diabetes?
What is the treatment for diabetes?
Exercise therapy
Diet therapy (diabetic diet)
Drug therapy
How is diabetic treatment monitored at home?
Blood glucose reagent strips
Blood glucose meters
Urine glucose tests
Tests for urinary ketones
What additional monitoring does the doctor do?
Blood glucose
Continuous glucose sensors (CGMS)
Hemoglobin A1C testing
Diabetic Home Care and Monitoring At A Glance
Related diabetic home care articles:
Diabetes diet Ò on WebMD

What is diabetes?

Diabetes mellitus is a condition in which the body does not produce enough insulin or the insulin that is produced is ineffective. Insulin is produced and secreted by the pancreas and is needed for the proper storage and utilization of nutrients (glucose, proteins, and fat) by the cells of the body. Insulin allows nutrients to enter the cells of the body. For example, insulin allows cells to remove glucose from the blood, and the glucose is used to generate the energy that is necessary to fuel the activities of the cells. When insulin is absent or ineffective and the cells receive inadequate amounts of glucose, the body releases more glucose into the blood in an attempt to overcome the block to glucose entering the cells. The additional glucose cannot penetrate the cells, of course, and the glucose levels in the blood rise. High levels of blood and urine glucose is what causes the symptoms and signs of diabetes. For more, please read the Diabetes article.

What is the treatment for diabetes?

Diabetes is managed with a combination of exercise, diet and medication. The goal of therapy is to control blood glucose levels in order to prevent the immediate signs and symptoms of high blood glucose levels, as well as prevent the longÒterm complications of diabetes. The appropriate treatment for an individual depends on the type of diabetes and its severity. Type 1 diabetes mellitus is treated with insulin, exercise, and a diabetic diet. Type 2 diabetes mellitus is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugars, oral medications are used. If oral medications are still insufficient, insulin medications are considered.

Exercise therapy

Regular aerobic exercise improves blood circulation and lowers blood glucose levels. Exercise also strengthens the heart and helps maintain an ideal body weight. The chosen aerobic exercise should use large muscle groups. Running, walking, biking, and swimming are excellent activities for most people. The frequency, type, and duration of exercise depend on the individual's age, treatment goals, and physical ability. An exercise program should be designed with the help of a healthcare provider.

Exercise increases or decreases blood glucose levels depending on the concentration of glucose and insulin in the blood at the time of the exercise. If blood glucose is low or normal, exercise may cause hypoglycemia (low blood glucose) due to the utilization of glucose by the active muscles. On the other hand, exercise may cause hyperglycemia (high blood glucose) if there isn't enough insulin to allow the active muscles to utilize blood glucose. As a result, the muscles signal the body to produce more glucose, and the glucose accumulates in the blood. Therefore, food intake and insulin doses should be adjusted based on the intensity and duration of the anticipated exercise.

Diet therapy

Diet is another very important part of the management of diabetes. Some adult onset (nonÒinsulin dependent or type 2) diabetics can be controlled with diet and exercise alone. The right diet can help control blood glucose levels, reduce blood cholesterol, maintain an ideal body weight, and delay the complications of diabetes. Like exercise, diet therapy is tailored for each person. A successful diet should ideally take into consideration the person's ethnic background, financial situation, and lifestyle. It also should be simple since it may be more difficult to stick to diet plans with complex food exchanges.

Diabetics are often advised to use alternative ("artificial") sweeteners. Sweeteners are either nutritive or nonÒnutritive. Nutritive sweeteners such as sorbitol and fructose provide calories but may not raise blood glucose levels as much as regular sugar. NonÒnutritive sweeteners such as saccharin and aspartame do not contain calories. Both types of sweeteners are acceptable, but the caloric content of the nutritive sweeteners should be considered when calculating the daily intake of calories. In addition, large quantities of sorbitol can cause diarrhea, and fructose may contribute to some of the complications of diabetes.

Drug therapy

Drug therapy for diabetes requires medications available only by prescription. Insulin may be given by injection beneath the skin. Oral medications are available that increase the release of insulin from the pancreas and/or increase the responsiveness of the body's cells to the insulin that already is produced by the body.

How is diabetic treatment monitored at home?

The goal of diabetic therapy is to control blood glucose levels and prevent the complications of diabetes. Glucose levels are lowered into a normal range, if possible, but it is important not to reduce the levels to abnormally low levels which can cause symptoms such as sweating, increased heart rate, and even loss of consciousness. Therefore, it is necessary not only to treat the diabetes but to monitor the effects of treatment on blood glucose levels to avoid overtreatment or undertreatment of the diabetes.

There are two types of tests for blood glucose monitoring in the home. The first type uses a reagent strip, and the second type uses a reagent strip and a glucose meter.

Glucose also can be measured in the urine. Ketoacidosis is a complication of the inadequate treatment of diabetes. This condition can be identified by testing the urine for ketones.

Blood glucose reagent strips

Reagent strips are saturated with glucose oxidase, an enzyme that interacts with glucose. When a drop of blood is placed on the strip, the glucose oxidase chemically reacts with the blood glucose and the resultant reaction produces a color change on the strip. The higher the glucose level, the greater the reaction and the more dramatic the color change. The blood glucose level can be determined by comparing the color of the strip with a color chart. For accurate results, test strips should be stored at room temperature and away from moisture. To protect the strips from moisture, bottles should be closed after use.

The disadvantage of reagent strips alone is that they do not give an exact glucose measurement. They are accurate enough, however, to alert patients to seriously high or low levels of glucose. Examples of reagent strips that are available overÒtheÒcounter (OTC) are Chemstrip bG and Glucostix. For an accurate blood glucose level, the reagent strip must be combined with a blood glucose meter.

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