Monitoring is an essential part of the treatment type 1 diabetes. This includes the following:
You (or your child) should check blood sugar levels before taking insulin. Blood sugar levels can be monitored using a home blood glucose monitoring kit. This includes a special device to obtain a drop of blood, which is then tested for glucose. Your doctor will show you how to use the monitoring kit.
To obtain the drop of blood, you may use a:
- Lancet—a disposable, sharp, needle-like sticking device
- Lancet device—a spring-loaded finger-sticking device
The drop of blood is applied to a chemically treated test strip used with a glucometer—a device that reads the test strip and gives you a digital number value—to interpret your results.
Blood sugar should be tested at least four times per day (before breakfast, lunch, dinner, and bedtime). However, you or your child may be asked to test more frequently. Work with your doctor to determine what schedule works best.
Most kits provide a record diary so that you can keep track of your results. If not, your doctor may be able to provide you with one. Write down the results immediately—it is easy to forget the number. Always bring your record diary and glucometer with you when you or your child visits the doctor. Most modern glucometers can be downloaded and the results printed out for your doctor. Blood glucose levels are the single most important component to developing treatment and monitoring control.
A blood glucose monitor may become less accurate over time. Be sure to test your monitor for accuracy at least once a month, or anytime you suspect a problem. Check the manufacturer's directions to find out how to test your monitor. This will often mean using a "control solution" that is included with your glucometer.
HbA1c gives an indication of your average blood glucose level over 2-3 months. It is done in your doctor's office and requires only a blood sample. You are not required to fast before this test.
The results of HbA1c tests are given in percentages and are interpreted as follows:
- Less than 7%: good control of your diabetes
(Some medical experts believe that excellent control requires levels under 6.5%.)
- 7%-8%: moderate control
- 8%-9%: fair control
- Greater than or equal to 9%: poor control
Note: For a person without diabetes, a normal HbA1c is 4%-6.5%.
Studies show that people who maintain HbA1c levels close to 7% are less likely to develop long-term complications of diabetes than people whose HbA1c levels are 9% or higher. However, any drop in A1c levels reduces the risk of complications. Unfortunately, achieving low HbA1c's may also increase the risk of hypoglycemia. Talk with your doctor about setting specific HbA1c goals.
You may be asked to test your urine for ketones, usually only if blood glucose levels are consistently high. Ketones are produced when diabetes is poorly controlled and you are not receiving enough insulin. Instead of using glucose for energy, the body breaks down excess fats—a by-product of which is ketones. Large amounts of ketones in the body can lead to a condition called ketoacidosis, which can be deadly and requires medical attention.
When testing for ketones, it is important that you follow the directions precisely. The kit provides individual-use chemically treated strips. Pass the strip through the stream of urine or place it in a container of urine. Compare the strip against a color chart provided to determine if ketones are present.
The best time to conduct the test is in the morning before breakfast and any time your blood sugar is over 240 mg/dl (13.3 mmol/L) on the blood glucose test.
Call your doctor if you have positive results on the ketone test.
Since type 1 diabetes affects several systems in your body, your doctor will likely refer you to several specialists to help prevent and/or manage the complications of this disease. The specialists will probably include several of the following:
- Endocrinologist: a diabetes specialist
Ophthalmologist: an eye specialist for dilated exams
- In some states, an optometrist is licensed to administer drops that dilate the eye. After diabetes has been present for about ten years, all diabetics should have a yearly dilated eye examination by an ophthalmologist or optometrist.
- Podiatrist: a foot specialist, especially if you have decreased sensation in the feet
- Diabetes nurse educator to help with understanding insulin
- Diabetes dietitian educator to assist with meal planning
- Social worker, psychologist, or other mental health professional
Diabetes education is important. The United States goals for improving population health,
Healthy People 2010, note that too few diabetics receive diabetic education and recommend that a major public health goal be increasing the proportion of persons with diabetes who receive formal diabetic education.
If your blood glucose levels are outside of the target range, report this to your doctor. If this happens often, you (or your child) and your doctor may need to make a change in the treatment plan. Also, if you start to feel any new symptoms, talk to your doctor. You (or your child) may need a referral to a specialist for further care.