How often should I perform automatic blood sugar (BS) checks?

Frequency of Automatic Blood Sugar Checks

Most patients on intensive insulin regimens (multiple daily injections or insulin pump therapy) should perform blood glucose monitoring prior to meals and snacks, at bedtime, prior to exercise, when they suspect low blood glucose, after treating low blood glucose until normoglycemic, and prior to critical tasks such as driving, which typically requires 6-10 checks daily. 1

Blood Glucose Monitoring Frequency Based on Treatment Regimen

For Patients on Intensive Insulin Therapy (Type 1 or Type 2)

• Check blood glucose 6-10 times daily, including:
  • Before each meal and snacks
  • At bedtime
  • Occasionally postprandially (especially when using rapid-acting insulin)
  • Prior to exercise
  • When suspecting hypoglycemia
  • After treating hypoglycemia until normoglycemic
  • Before driving or critical tasks
  • Weekly monitoring at 3:00 am to detect nocturnal hypoglycemia 1

For Patients on Basal Insulin Only (Type 2)

• Check blood glucose at least once daily, focusing on fasting glucose to guide basal insulin adjustments 1
• Additional monitoring may be needed when:
  • Adjusting insulin doses
  • Experiencing symptoms of hypoglycemia
  • During illness or stress
  • When changing treatment regimens 1

For Patients on Non-Insulin Therapies (Type 2)

• Routine monitoring may be of limited additional clinical benefit by itself 1
• However, monitoring can be helpful when:
  • Altering meal plans
  • Changing physical activity
  • Adjusting medications (particularly those that can cause hypoglycemia)
  • When used in conjunction with a treatment adjustment program 1

Optimizing Blood Glucose Monitoring

Accuracy and Technique

• Ensure proper monitoring technique through regular evaluation 1
• Use FDA-approved meters with unexpired test strips 1
• Be aware of factors that can interfere with glucose meter accuracy:
  • Medications (high-dose vitamin C)
  • Hypoxemia
  • Hematocrit levels 1

Effective Use of Monitoring Data

• Patients should be taught how to use blood glucose data to adjust:
  • Food intake
  • Physical activity
  • Medication dosing 1
• Review and interpret monitoring data regularly with healthcare providers 1
• Integrate results into diabetes management plans 1

Special Considerations

Continuous Glucose Monitoring (CGM)

• CGM may be beneficial for:
  • Adults with type 1 diabetes (particularly those ≥25 years)
  • Patients with hypoglycemia unawareness
  • Those with frequent hypoglycemic episodes 1
• Success correlates with adherence to ongoing use 1
• CGM requires robust education, training, and support for optimal implementation 1

A1C Testing Frequency

• Perform A1C testing at least twice yearly in patients meeting treatment goals with stable glycemic control 1
• Perform quarterly A1C testing in patients whose therapy has changed or who are not meeting glycemic goals 1

Common Pitfalls to Avoid

• Not acting on monitoring results - many patients check blood glucose but take no action when results are high or low 1
• Inappropriate technique leading to inaccurate readings 1
• Insufficient monitoring frequency for insulin regimen type 1
• Overuse of monitoring when not clinically indicated 1
• Not reevaluating the need for and frequency of monitoring at routine visits 1

Blood glucose monitoring is an essential component of effective diabetes management, particularly for insulin-treated patients. The frequency should be tailored to the individual's treatment regimen, with more frequent monitoring required for those on intensive insulin therapy to prevent complications and optimize glycemic control.