Before you begin - How to use this manual

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2 Before you begin - How to use this manual When you sign up for the Type 2 Testing Program, you receive a free blood glucose meter and subscribe to receive test strips each month, quarter or year. Your test strips will come with lancets. The number of test strips you receive will allow you to conduct 1-2 tests a day. This manual contains a structured testing plan for you to test your blood glucose levels and understand how diet, exercise and other lifestyle factors can affect these levels. What s the idea behind the Type 2 Testing Program? The idea is simple: use the test strips to test your blood glucose in order to selfmonitor your diabetes and understand how food, diet, lifestyle choices and illness can all affect your blood glucose. There is growing evidence that self-monitoring of blood glucose (SMBG) is hugely beneficial for individuals with type 2 who are not treated with insulin. This evidence is based on studies that show SMBG can assist type 2 diabetics to better understand their condition and provide a means to actively and effectively participate in its control and treatment, and should therefore be considered as part of their ongoing diabetes self-management education. You should use the results you obtain from your blood glucose tests to make lifestyle changes (if required) that will help you maintain blood glucose levels within recommended ranges. This manual has been written to help educate and support you with everything you need to know about your blood glucose and testing it i.e. how to test, when to test, how many times to test and ultimately, how to use your test results. I have a question Log into the Type 2 Testing Program at Type2Testing.com and watch educational videos on each aspect of the manual. From how to test your blood glucose to how to act on your results, you will find a video for each chapter of this manual. If you have any questions at all, please log into the Type 2 Testing Program at Type2Testing.com and browse the FAQs or post your own questions there. Last reviewed: January

3 Table of Contents Introduction what is self-monitoring? What does SMBG involve? Benefits of testing for type Better understanding of diabetes/more control 6 Reassurance & motivation 6 Diabetes regression/remission 6 Avoiding complications 6 GP assistance 6 3. How to test your blood glucose When should I test? How many times should I test? Focused SMBG regimens 10 Benefits of Focused SMBG regimens 11 Is this type of testing suitable for me? 12 Example of SMBG over a month What should my blood glucose levels be? Hypoglycaemia What is hypoglycaemia? 16 Do I need to be aware of hypoglycaemia? 16 What causes hypoglycaemia? 16 What are the symptoms? 16 Dangers of hypoglycaemia 17 How do I treat a hypo? 17 When to call for medical help Hyperglycaemia What is hyperglycaemia? 19 Do I need to be aware of hyperglycaemia? 19 What causes hyperglycaemia? 19 What are the symptoms? 19 Treatment for hyperglycemia 20 Last reviewed: January

4 When to call for medical help Recording test results Blood glucose monitoring diaries 21 What to make note of 21 mylifestyle What do my results mean? Spotting patterns 22 Low blood sugar levels before or after meals HbA1c What is HbA1c? 26 Why is it important 26 How is HbA1c tested? 26 Benefits of blood glucose testing on HbA1c Talking to your doctor Will my GP support my self-blood glucose testing? 28 What if my GP is not supportive? 28 What to say to my GP if they don t agree on the benefits of selfblood glucose testing? 28 What if my GP is happy with my progress? 29 Last reviewed: January

5 Introduction what is self-monitoring and why should I be interested? Self-monitoring of blood glucose levels for people with non-insulin dependent type 2 diabetes is currently a grey area. Despite it not being recommended on a blanket basis for all people with type 2 diabetes, there is growing evidence that self-monitoring of blood glucose (SMBG) is hugely beneficial for individuals with type 2 who are not treated with insulin. This evidence is based on studies that show SMBG can assist type 2 diabetics to better understand their disease and provide a means to actively and effectively participate in its control and treatment, and should therefore be considered as part of their ongoing diabetes self-management education. Last reviewed: January

6 1. What does SMBG involve? Self-monitoring of blood glucose (SMBG) typically consists of the following: Establishing both pre-meal and post-meal blood glucose targets Testing blood glucose levels Recording these levels along with additional useful information Analysing the data to see if any patterns emerge Assessing any influencing factors Taking action to reduce the impact of future high or low blood sugars Regularly monitoring your blood glucose levels to evaluate the impact of actions taken / to see how effective the actions have been Last reviewed: January

7 2. Benefits of testing for type 2 The benefits of self-monitoring of blood glucose (SMBG) in type 2 diabetes highlighted in research papers include: Better understanding of diabetes/more control SMBG can help you to understand how your blood sugar levels respond to the food you eat, thus allowing you to make the necessary lifestyle adjustments needed to achieve your blood glucose targets and take control of your condition. Reassurance & motivation SMBG offers instant results and continuous feedback, which can be both reassuring and self-empowering. Diabetes regression/remission Improved blood sugar control through SMBG and subsequent informed diet and lifestyle choices could put your diabetes into remission, which may allow you to come off any diabetes medication you are taking. Avoiding complications Better blood sugar control can mean a considerable reduction in HbA1c levels, which in turn, lowers the risk of developing both macrovascular complications (including heart disease and stroke) and microvascular complications (including eye, kidney and nerve damage) of diabetes. GP assistance SMBG can help GPs make informed decisions based on their patient s results. For example, if you are experiencing hypoglycaemia (abnormally low blood glucose levels) once or twice a week, your doctor may decide to reduce a dose of a particular drug or switch you onto a different medication. Sources: Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: results from the Structured Testing Program study. Diabetes Care 2011;34: Intensive Structured Self-Monitoring of Blood Glucose and Glycemic Control in Noninsulin-Treated Type 2 Diabetes: The PRISMA randomized trial. Diabetes Care October 1, : Last reviewed: January

8 Using Self-Monitoring of Blood Glucose in Noninsulin-Treated Type 2 Diabetes. Diabetes Spectrum May 1, : Self-Monitoring of Blood Glucose in Noninsulin-Using Type 2 Diabetic Patients: Right answer, but wrong question: self-monitoring of blood glucose can be clinically valuable for noninsulin users. Diabetes Care January 1, : The effectiveness of SMBG depends on a number of factors, most notably your willingness and ability to use SMBG appropriately. For example, you must: Possess the knowledge and skill to accurately perform SMBG and record test results and related events (manually or electronically) Know how to accurately interpret blood sugar readings to identify issues with your diabetes control and make appropriate changes to your lifestyle changes and drug treatment plan This programme will help equip you with the knowledge and techniques to get you started with making sense of your blood glucose results and help you, together with your doctor, to make changes to your lifestyle and treatment regime. Last reviewed: January

9 3. How to test your blood glucose Self-monitoring of blood glucose levels (SMBG) is a relatively straightforward process. To show you what this involves, we ve put together the following step-by-step guide: Step 1: Start by preparing your kit, which should include your meter, a test strip to hand, lancing (finger pricking) device, cotton wool (optional) and a monitoring diary to record the results Step 2: Wash and dry your hands thoroughly and then warm them up the colder they are, the harder and more painful it will be to draw blood. Step 3: Load a new lancet into the lancing device and put a test strip into your blood glucose meter most meters will automatically switch on at this point. Step 4: Prick the side of your finger not the forefinger or thumb - as it hurts less there than at the tips or the pads. Step 5: Give your finger a gentle squeeze until blood appears. If you find you have to squeeze too hard to produce blood, hold your hand down towards the ground to increase blood flow and try pricking a different finger *Using a different finger, and a different part, each time you test, is recommended as it will be less painful. Step 8: Once blood appears, check the meter is on and then transfer the blood onto the test strip. A result will be provided within 10 seconds. Step 9: If the test is unsuccessful, repeat from step 4. Step 10: If the test is successful, clean your finger using the cotton wool and dispose of both the test strip and lancet (the latter must be disposed of in a sharps bin). Step 12: Finally, record your results in a monitoring diary as this will help you and your healthcare team determine whether any adjustments need to be made to your treatment. Last reviewed: January

10 4. When should I test? Knowing when to test blood sugar levels can help you get more out of self-blood glucose monitoring. Testing before and after certain meals to see how your sugar levels and medication respond to the food you eat is hugely beneficial. But there are several other situations in which short-term focused SMBG may be beneficial to people with noninsulin-treated type 2 diabetes. These include: Making adjustments in medication, nutrition and/or physical activity Travelling New life experiences, such as going away to university, starting a new job or changing work hours Experiencing worsening HbA1c readings Being unsure or in need of additional information about the nature of type 2 diabetes and/or the impact of treatment (non-pharmacological and pharmacological) on blood glucose control Being pregnant or planning to become pregnant Experiencing symptoms of hypoglycaemia (low blood sugar) Experiencing symptoms of hyperglycemia (high blood sugar), particularly if for prolonged periods (several hours) Being pregnant or planning to become pregnant Periods of stress Very hot/cold weather Being ill or contracting an infection When testing before a meal, try to test within a few minutes of eating where practical. When testing after a meal, start 2 hours from the time you started your meal. Last reviewed: January

11 5. How many times should I test? Blood glucose testing can be carried out intensively over several days, or on an ad hoc basis in response to specific events, such as testing blood glucose levels in response to a new diet. When starting self-monitoring of blood glucose (SMBG), you should ideally test up to twice a day to help you get accustomed with the process/procedure. For example, you could start by obtaining blood glucose values before and after alternating meals each day over a two week period. Example of a staggered SMBG regimen/plan: Prebreakfast Postbreakfast Prelunch Postlunch Predinner Postdinner Monday x x Tuesday x x Wednesday x x Thursday x x Friday x x Saturday x x Sunday x x Once you are familiar with blood glucose testing, a staggered SMBG regimen can be followed by a more intensive testing routine. Focused SMBG regimens/plans Focused SMBG regimens or testing plans involve testing often over the course of 1 to 5 days to allow you to build up a useful set of patterns. Focused regimens can be quite intensive, particularly the 7-point testing plan (also referred to as the 7-point profile) shown below. To prevent fatigue or distress from over testing, it is generally recommended to perform a focused SMBG regimen no more than twice a month or over consecutive weeks, particularly if you are new to testing. Examples of focused SMBG testing: Last reviewed: January

12 5-point testing plan Monday Tuesday x x x x x Wednesday x x x x x Thursday Friday Saturday Sunday Bedtime Note that a staggered regimen can also be applied to a focused 5-point plan. An example of this combined approach is shown below: Monday Tuesday x x x x x Wednesday Thursday x x x x x Friday Saturday x x x x x Sunday 7-point testing plan Prebreakfast Postbreakfast Prelunch Postlunch Predinner Postdinner Prebreakfast Postbreakfast Prelunch Postlunch Predinner Postdinner Prebreakfast Postbreakfast Prelunch Postlunch Predinner Postdinner Monday Tuesday Wednesday x x x x x x x Thursday x x x x x x x Friday Saturday Sunday Benefits of Focused SMBG regimens/plans Bedtime Bedtime A focused SMBG regimen allows you and your doctor to identify patterns of control and thus make appropriate changes, such as changes to your diet, to further improve your blood glucose levels. Last reviewed: January

13 Research has shown that performing a 7-point testing plan for three consecutive days, once every three months, can help improve blood glucose control in people with type 2 diabetes. Is this type of testing suitable for me? Focused SMBG regimens may be particularly beneficial for people with non-insulin treated type 2 diabetes who wish to: Start blood glucose testing to get an understanding of how blood glucose levels vary throughout the day Learn how different foods and meals affect blood glucose levels See how a new medication or dosage is affecting blood glucose Learn how blood glucose levels respond to illness or stressful events that may last for a number of days. Additionally, a focused SMBG plan may also be useful going through a change that could affect lifestyle, including: Starting a new job Changing working hours Becoming more or less active Being pregnant or planning pregnancy Example of SMBG over a month The following example shows how staggered and focused SMBG regimens (both 5- point and 7-point testing plans) can be combined through a month of testing. Note the table shown on the following page is only a suggested programme and you can choose to vary the days you test to suit your needs. Last reviewed: January

14 Day Prebreakfast Postbreakfast Prelunch Postlunch Predinner Postdinner Bedtime 1 Monday x x 2 Tuesday x x 3 Wednesday x x 4 Thursday x 5 Friday x 6 Saturday 7 Sunday 8 Monday 9 Tuesday x x x x x 10 Wednesday 11 Thursday x x x x x 12 Friday 13 Saturday x x x x x 14 Sunday 15 Monday 16 Tuesday 17 Wednesday 18 Thursday 19 Friday 20 Saturday 21 Sunday 22 Monday 23 Tuesday 24 Wednesday x x x x x x x 25 Thursday 26 Friday 27 Saturday 28 Sunday 29 Monday 30 Tuesday 31 Wednesday In the above example, a staggered SMBG regimen is used over the first week to test before and after each meal as well as before and after sleep. During the second week, a staggered 5-point testing plan/profile is followed across a period of 5 days, with a day s break included between each of the testing days. Notice that, on testing days, tests are done before each meal and before bed, with one post meal test also included on each day. The post meal test is varied, through breakfast, lunch and dinner across the three days of testing. The user then gives their fingers a rest for 10 days before finishing with a 7-point plan of focused testing over the course of a single day. Last reviewed: January

15 If, for any reason, you would like more test strips to allow you test more frequently, you can purchase additional test strips and lancets for your GlucoRx meter in the Diabetes Shop. Last reviewed: January

16 6. What should my blood glucose levels be? An essential part of diabetes self-management is understanding blood glucose level ranges. For people with type 2 diabetes, blood sugar level targets are as follows: Before meals (pre prandial): 4 to 7 mmol/l (millimoles per litre) 2 hours after meals (post prandial): under 8.5mmol/L These ranges are recommended by the National Institute for Clinical Excellence (NICE) and compare to normal or non-diabetic target ranges of 4.0 to 5.9 mmol/l (pre prandial) and under 7.8 mmol/l (post prandial), as set by the International Diabetes Federation (IDF). Each person is different and your target range will ultimately be set by your doctor or diabetic consultant after discussing your individual needs. Last reviewed: January

17 7. Hypoglycaemia A fall in your blood sugar levels can lead to hypoglycaemia, a common short term complication of diabetes mellitus. What is hypoglycaemia? Hypoglycaemia, also referred to as a hypo, develops when the concentration of glucose in the blood falls to a dangerously low level of less than 4 mmol/l (millimoles/litre). Do I need to be aware of hypoglycaemia? It is important to be aware of hypoglycaemia if you are on any of the following diabetes medications: Sulphonylureas, which include: Glibenclamide Gliclazide Glipizide Glimepiride Tolbutamide Prandial glucose regulators (also called Glinides): Repaglinide Nateglinide If you are not taking any of these oral medicines, and are not on insulin either, you can skip to the next section. What causes hypoglycaemia? There are a number of factors that can cause an unexpected drop in blood sugar levels. These include: Unplanned or more strenuous exercise than usual Delayed or missed meals Lack of carbohydrates Drinking alcohol without food Taking an overdose of your diabetes medication What are the symptoms? Last reviewed: January

18 Warning signs of hypoglycaemia vary from person to person but generally include: Sweating Dizziness Hunger Tingling in the lips Trembling Irritability Confusion Disorientation Being aware of the early signs and causes of hypoglycaemia can help you avoid a hypoglycaemic attack or prevent a hypo from becoming severe, and this is where self-monitoring of blood glucose can help. In fact, regular blood sugar testing recommended for people with diabetes who experience regular hypoglycaemia. Dangers of hypoglycaemia Severe cases of hypoglycaemia are classed as diabetic emergencies as left untreated, they can lead to: Convulsions/fitting/seizures loss of conscious brain damage - each hypoglycaemic attack increases the risk of memory loss/dementia diabetic coma Loss of hypo awareness The more you times you have a hypo, the less sensitive your body becomes to it. This can lead to loss of 'hypo awareness' - a potentially life-threatening problem that can result in a person becoming unconscious without noticing any signs of hypoglycaemia. Loss of hypo awareness has implications for driving too as it can lead you losing your licence. How do I treat a hypo? If you think you are having a hypo, check your blood sugar levels as quickly as possible. If you cannot test your sugar levels, it is advisable to follow the hypo treatment below. If you find that your levels are below 4 mmol/l, healthcare professionals recommend taking approximately 10-20g of fast-acting carbohydrate, such as: Last reviewed: January

19 3 or more glucose tablets 5 small sweets (e.g. jelly babies) a small glass of fruit juice a small glass of regular (non-diet) soft drink This should be followed by 15 minutes later with 10-20g of longer-acting carbohydrate, such as a piece of fruit, some biscuits, half a sandwich, a small bowl of cereal, or the next meal if it is due. Left untreated, hypoglycaemia can cause loss of consciousness. In this instance, paramedics would need to administer a shot of glucagon (a hormone that raises blood glucose levels) or provide glucose intravenously. When to call for medical help In some cases, particularly during periods of stress or illness, you may find that your blood glucose levels do not settle back into range for a number of days. If you become concerned about your health during this time, contact your doctor or out of hours health team. Last reviewed: January

20 8. Hyperglycaemia Hyperglycaemia is the scientific term for high levels of blood sugar, which can cause damage to the body s organs if you regularly have prolonged periods of hyperglycaemia (or hypers ) over several months or years. What is hyperglycaemia? Hyperglycaemia occurs when the level of sugar in the bloodstream rises to: Over 7.0 mmol/l (126 mg/dl) when fasting; or 11.0 mmol/l (200 mg/dl) 2 hours after meals Do I need to be aware of hyperglycaemia? Hyperglycaemia is the characteristic of diabetes mellitus and all people with diabetes will benefit from an awareness of when blood glucose levels are higher than they should be. What causes hyperglycaemia? Bouts of hyperglycaemia, or hypers, can be caused by a number of things including: Missing a dose of anti-diabetic medication Eating more carbohydrates than your body and/or medication can manage Being mentally or emotionally stressed as a result of an injury, surgery or anxiety Stress Infection What are the symptoms? The main signs of hyperglycemia are increased urination, increased thirst and increased appetite. Other common symptoms of high blood sugar include: Fatigue Headaches Blurred vision Stomach pain Testing blood glucose levels will help you become aware of the warning signs of hyperglycemia, enabling you to take the right steps to prevent blood sugars becoming too high. Last reviewed: January

21 Treatment for hyperglycemia If your blood glucose values are too high, it will take time for your blood glucose levels to return back to the target range. This can take anywhere from up to one hour to a number of hours, and this tends to vary quite substantially between different people with diabetes. There are some steps you can take to help your blood sugar to return to normal levels. For example, numerous studies have shown walking to be an effective method of brining down high blood glucose levels. In one study, a 30 minute walk was associated with 2 mmol/l drop in blood sugar compared with resting. Source: Drinking sufficient carbohydrate free fluids, such as water, is also recommended, particularly if your blood glucose levels remain high for a number of hours as hyperglycemia can increase the chance of becoming dehydrated. When to call for medical help In some cases, particularly during periods of stress or illness, you may find that your blood glucose levels do not settle back into range for a number of days. If you become concerned about your health during this time, contact your doctor or out of hours health team. Last reviewed: January

22 9. Recording test results The readings you get from testing your blood sugar levels will need to be recorded in order for you to make sense of the numbers and spot patterns. Don't worry too much if the numbers appear to be totally random. Patterns may take days or even a few weeks before they start to emerge. Your doctor may be happy to help you to spot patterns amongst your results if you are having difficulty doing so. Blood glucose monitoring diaries Blood glucose values should be noted down in a blood glucose monitoring diary. A good blood glucose monitoring diary will include a decent amount of space for extra notes you may wish to take. Blood glucose monitoring diaries can be downloaded for free in PDF or Excel format at What to make note of In addition to your blood sugar results, there are a number of other things that should be recorded to help your understand your numbers. These include: Which meals you have had Whether you have had to delay or miss a meal Physical activity, including duration and intensity of exercise Illnesses and periods of stress as with exercise, these can both have an effect on sugar levels Notes of any symptoms of highs or lows Any significant change in temperature of your environment (e.g. an unusually hot or cold spell) Note down as much as you are able to as the more information you have, the better you can make sense of your results. But make sure you don t wear yourself out. Take just as much info as you need to be help build an understanding. mylifestyle Another way to record your blood sugar testing results is through mylifestyle, the free health system from Diabetes.co.uk that lets you monitor and keep track of your blood glucose levels, as well as your blood pressure, weight and body mass index (BMI), plus much more. Sign up to mylifestyle at Last reviewed: January

23 10. What do my results mean? The ultimate goal with blood glucose testing is to help with making changes that will improve your diabetes control. Self-monitoring of blood glucose (SMBG) can help you to spot patterns in your results and work with your doctor to suggest ways to improve your blood glucose control. Don t be put off testing if you are not reaching the target levels, as the key to testing is to make gradual progress. Even small reductions in your blood glucose levels can significantly reduce the risk of developing complications in the future. If you are making any significant changes to your diet or treatment, make sure your doctor agrees with the changes you intend to make. Spotting patterns Scenario 1: Generally on target before meals (between 4 and 7 mmol/l before meals) Frequent highs after meals (over 8.5 mmol/l 2 hours after starting a meal) This may indicate that either the meals you are having are too high in carbohydrate for your medication to adequately cope with. Actions you can take: - Reduce the carbohydrate content of your meals - Take an after meal walk ideally of 15 minutes or more - Speak to your doctor about the possibility of increasing or changing your medication Scenario 2: Generally on target before meals (between 4 and 7 mmol/l before meals) Occasional highs after meals (over 8.5 mmol/l 2 hours after starting a meal) This indicates that generally your body, and any medication you take, is responding well to the meals you are having. If you are looking to get even tighter control, you may wish to take either of the following actions. - Slightly reduce the carbohydrate or calorie content of the type of meals that have lead to the higher after meal results - Take an after meal walk ideally of 15 minutes or more Last reviewed: January

24 If the after meal highs are taking place at the same time of day (say just after breakfast), you can discuss with your doctor to together find the best way to handle the highs at this time of day. Scenario 3: Frequent highs before lunch, dinner or sleeping (over 7 mmol/l) If you are regularly experiencing highs at these times, it suggests that your body may be struggling to fully cope with the rise in blood sugar levels between meals. This could be the result of having too much carbohydrate or calories but could also be that your body needs a stronger or different type of medication or that you need to take more activity during the day. Actions you can take: - Reduce the carbohydrate content of the type of meals that have lead to the higher post-meal results - Take an after meal walk ideally of 15 minutes or more - Speak to your doctor about the possibility of increasing or changing your medication Scenario 4: Frequent highs before breakfast but not other meals (over 7 mmol/l) If you are experiencing regular highs before breakfast but not before other meals, it may indicate that you are experiencing dawn phenomenon, which is where the body releases glucose from the liver first thing in the morning in an attempt to prepare your body for the day ahead. The effect of dawn phenomenon may be increased by stress so bear this in mind and see if the trend continues over a few weeks. Actions you can take: - Increase your activity during the day - Discuss with your doctor alternative ways to combat dawn phenomenon Scenario 5: Occasional highs before meals (over 7 mmol/l) There are a number of reasons why you may be getting occasional highs before meals. Taking notes of what you are eating in the day, what activity you do, whether Last reviewed: January

25 you have had any stressful periods during the day or any signs of illness may help you to spot whether there is a pattern to explain the higher readings. Actions you can take: - Keep a note of activity levels and other factors - Discuss with your doctor any patterns that emerge Low blood sugar levels before or after meals If you are on sulphonylureas or prandial glucose regulators (glinides) as your diabetic medicine, you will need to be wary of any low blood glucose symptoms you may have and take note of any low blood glucose test results. Scenario 6: Frequent lows after meals (below 4 mmol/l) If you are getting frequent lows after meals, it suggests that your medication is too strong for the meals you are having. Actions you can take: - Speak to your doctor about the hypos you re having. They may advise you to reduce the medication you're taking or change the timing of your exercise. - If the hypos are taking place at a similar time of day, let your doctor know and he or she can suggest changes to prevent these hypos from occurring. Scenario 7: Occasional lows after meals (below 4 mmol/l) If you are getting occasional lows after meals, it may suggest that either some meals are too low in carbohydrate for your medication or dosage, or that another factor such as exercise is leading to the occasional lows. Actions you can take: - Speak to your doctor about the hypos you are having. They may advise you to reduce your medication or change the time you take exercise. Scenario 8: Lows before meals as well as lows after meals If you are getting lows before and after meals, this may be indicative that your medication is now too strong for your current lifestyle. Last reviewed: January

26 Actions you can take: - Speak to your doctor so the problem can be discussed and addressed. Changing your dose or medication is one of the options your doctor may suggest Scenario 9: Lows before meals but not after meals If you are getting lows before meals but not after meals, there could be a number of factors at play which could include your medication or dosage, activity levels, timing of meals or another factor. Actions you can take: - Note down factors such as what meals you ate prior to the low as well as any activity you took or any other potentially relevant factors (stress, warm weather, etc) - Speak to your doctor to discuss what the issue may be and how best to prevent these lows occurring Last reviewed: January

27 11. HbA1c HbA1c is a commonly used medical term in diabetes. It refers to a form of haemoglobin in your blood that is measured mainly to identify the average plasma glucose concentration over prolonged periods of time. What is HbA1c? In the body s metabolism, haemoglobin sticks to glucose in the blood, forming a glycated or glycosylated haemoglobin molecule, also known as haemoglobin A1c, A1c and HbA1c. The more glucose found in the blood the more glycated haemoglobin (HbA1c) will be present. Why is it important Because HbA1c can be measured, it serves as a marker for average longer-term blood glucose levels. Haemoglobin molecules usually live for 8-12 weeks, which means they can give an average blood glucose reading for previous 2-3 months from the date of your HbA1c test. For people with diabetes, an HbA1c level of 6.5% is considered good control. Research shows that a permanent reduction in HbA1c of 1% can significantly reduce the risk of developing long term complications, including a 16% decrease in the risk of developing heart disease and 43% decrease in the risk of needing an amputation. How is HbA1c tested? An HbA1c reading is often taken from a blood sample from your arm. In some cases, it may also be taken from blood from a finger. Benefits of blood glucose testing on HbA1c Whilst HbA1c is very good at providing a good idea of your diabetes control over a period of 2 to 3 months, it is not so good at helping you to work out how medication, diet, activity and other parts of your daily life are each playing a part in your diabetes control. This is where self-monitoring of blood glucose (SMBG) can be a great help. As we have mentioned, taking tests will help you to identify daily or weekly patterns and take appropriate action to help improve your overall control. Last reviewed: January

28 In fact, various studies have shown that lifestyle intervention and pharmacological therapy based on SMBG leads to greater reductions in both blood glucose and HbA1c readings than standard HbA1c-based treatment (i.e. reviewing HbA1c every 3 or more months and then attempting to make lifestyle/treatment changes). *Note that the changes may sometimes take a bit of time to have an effect on your HbA1c result, so don t be disappointed if your next HbA1c does not show a significant reduction. Stick with testing and understanding your diabetes and in time you will start to see the benefits. Last reviewed: January

29 12. Talking to your doctor Effective self-monitoring of blood glucose (SMBG) depends on a number of factors, including support from your GP. Will my GP support my self-blood glucose testing? Support for SMBG in non-insulin treated patients with type 2 diabetes can often vary from one health centre to another. The support you receive may include any of the following: Access to diabetes management courses Personal support from your GP, consultant, diabetes specialist nurse or practice nurse Blood glucose testing supplies on prescription What if my GP is not supportive? There are a number of reasons why your GP may not support or encourage you to test your blood glucose levels. These may include: - Time pressures on your GP - Budget pressures for your GP - Lack of educational resources - Anxieties over how you may interpret the results - An opinion that self-monitoring of blood glucose in type 2 non-insulin dependent diabetes is not helpful In many of these cases you may need to work with your GP and agree compromises on how much support you can receive. What to say to my GP if they do not agree on the benefits of self-blood glucose testing? You can assure your GP that you will be taking a steady approach to blood glucose testing. You can also reassure your GP that you will record your blood glucose results and have results for them to review at your next diabetic review or otherwise at a time that is convenient for him/her. In most cases, your GP should be happy for you to monitor your condition in this way. Last reviewed: January

30 If you feel your GP is being unreasonable in handling your request for support with your home self-monitoring of blood glucose, contact your local PALS (NHS Patient Advice and Liaison Service). What if my GP is happy with my progress? If your GP is happy with the progress you are making, they may be willing to provide test strips for you on prescription. *Note that this outcome is not guaranteed and if test strips are provided, your GP may wish to limit the number of test strips you receive. Last reviewed: January