Constant monitoring of blood sugar mandatory

Dr Jothydev Kesavadev | 10-June-2013

Diabetes unlike any other disease, mainly involves treatment of three parameters: blood sugar, blood pressure and cholesterol. All these require continuous monitoring and modifications in the treatment regimen on a periodic basis

By Dr Jothydev Kesavadev, MD

There are several therapies for diabetes and patients have to spend sufficient time with diabetes educators, or pharmacist to learn in depth on the timing and method of administration of injections and oral drugs. The sulfonyl urea group of drugs like glimepiride or glycozide has to be taken 10-15 minutes before food. Metformin can be taken before food or after food in the case of abdominal discomfort. Alpha glucosidase inhibitors like Acarbose, Voglibose or Miglitol should be administered along with food. In addition to individually packed drugs, many drugs are available as combinations of two or more drugs and it is absolutely mandatory that patient should have sufficient knowledge on when and how to take all these drugs. 

Comprehensive treatment of diabetes to prevent long term complication will involve multiple drugs in addition to the usual ones to normalise the blood sugar. This includes statin to reduce cholesterol, ACEI/ARB to normalise blood pressure and also microalbuminuria if any. Uncontrolled blood pressure may require one or even upto five different drugs. 

The ultimate aim of therapy should be to achieve targets for all metabolic parameters. The absence of continuing treatment with multiple drugs without achieving targets of therapy may be considered equivalent to no treatment.

Monitoring in diabetes

Diabetes unlike any other disease, mainly involves treatment of three parameters: blood sugar, blood pressure and cholesterol. All the three require monitoring and modifications in the treatment regimen on a periodic basis. Blood sugars are ideally monitored with the help of a quality glucometer. 

The frequency and timing of monitoring is based on type of diabetes and mode of treatment. In Type 1 diabetes, blood sugar has to be monitored four-eight times daily and dose of insulin is determined based on the blood glucose value before food. In Type 2 diabetes, less frequent monitoring is sufficient.Postprandial increases in the blood sugars are strongly linked to heart attacks, strokes and cancers in diabetics. In an individual without diabetes, blood sugar value measured two hours after food will never go above 140 mg/dL.

In subjects with uncontrolled blood pressure or with kidney disease it is recommended to have home blood pressure monitoring as well. Though home monitoring of parameters sounds expensive, in the long run it is extremely cost effective. In the absence of such monitoring, treatment expenses in diabetes will reach 10-20 times higher after 15-20 years of diabetes due to the occurrence of several complications.

Continuous glucose monitoring

We at Jothydev’s Diabetes Research Centre started performing continuous glucose monitoring (CGM) way back in 2004-2005. In the past, it was a sophisticated investigation, but now this investigation has become very simple and an easy to perform routine technology. 

Unlike a blood glucose which is measured in the laboratory or in a glucometer,  continuous glucose monitoring as the term indicates provides a video of blood glucose reading measured once in every 5-10 minutes continuously from one  day to several days.  A tiny sensor needle is attached to the skin of the abdomen to record the blood glucose reading. This is a painless procedure and this sensor will measure the voltage in the interstitial fluid which gets translated into blood sugar values. The blood sugar values can be downloaded or uploaded to official websites which will generate graphs on each date of the monitoring. Continuous glucose monitoring data will provide different trends of blood glucose variations. The data can be intelligently utilised for making therapeutic decisions, for example, to change the type of insulin or to introduce other oral therapies etc. 

Studies have shown continuous glucose monitoring data are critical in evaluating the blood glucose variations in response to diet, exercise, emotions, anger etc. CGM is a unique investigation since it provides the blood glucose continuously, including the time when the patient sleeps. Hypoglycemia unawareness or the existence of autonomic neuropathy as a complication of diabetes which is so severe that the patient is not even aware of a dangerously low sugar can easily be picked up with the help of CGM. Initially, CGM was only a research tool and now it has gradually evolved as a part of routine investigation in both Type 1 and Type 2 diabetes. Being a relatively new technology, it goes without saying that CGM is a little bit expensive.

(Dr JothydevKesavadev is the CEO and Director of Jothydev’s Diabetes Research Centre)

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