MONITORING TARGETS: TREATMENT TARGETS TO BE FIXED ARE:
( Less Stringent Targets For Elderly ,Fragile patients or Those who have No family support or have other serious diseases compromising their lives or Life Expectancy)
Fasting Blood Glucose < 110 -120 mg %
Postprandial at 2H after meals < 160 mg% ( tolerate 180 in elderly)
Random at any time of the Day < 140 mg%
Yes we are indeed TIGHT on glucose , especially in young patients !
HbA1c < 6.5%
Total Cholesterol < 180 mg % HDL-Cholesterol(Good one) > 40 mg % in males & > 50 mg % in females
Triglycerides < 150 mg %
LDL-Cholesterol < 100 mg %, In High Risk < 70 and in Very High Risk < 55 mg % )
( for example If you have Heart Disease/PAD/TIA/Stroke- < 55 mg%)
Blood Pressure < 140 / 90
(& if you have kidney disease then less than 130 / 80
And do not care what your lab gives you as normal reference range, remember only these above given levels !
Looking Beyond HbA1c: Continuous Glucose Monitoring or CGM
On many occasions doctors can feel that patients do show a good HbA1c report but their overall condition and/or Self Recorded Blood Glucose Readings are not in line with the A1c report. There are also many other important parameters which are important for defining a Good Control BUT are not shown up in an HbA1c Report. For example day to day variations or IntraDay variations i.e: ups and downs cannot be measured or even sensed from HbA1c reading which actually gives you an idea of average Glucose your body has been exposed to , in past three months.
To actually record what is happening throughout the day in terms of Glucose fluctuations in blood, we undertake CGM or Continuous Glucose Monitoring in our patients, With CGM data a software can give us a Graphic record of all those Glucose measurements which the system has made over a period of seven to fourteen days. This app also tells us how much percentage of time your blood glucose remained in a desirable range of 70-250mg %-Time In Range.
Monitoring Your Health and Treatment:
At the beginning –Get the following done (Minimum):-
Fasting and PP-after meals- Blood Glucose.
Please note that if you are on treatment then glucose has to be tested with your regular dose of medicines and /or Insulin. Because the idea is to see and check how your treatment is working for you!
CBC, Kidney Function with Electrolytes, Liver Function Tests, Lipid Profile, HbA1c, Thyroid Function Test, complete Urine Examination.
Micral – or Microalbuminuria or Albumin in Urine – Should always be less than 30 mg per day. Should only be tested when blood glucose is normal, there is no infection, no heart failure & certainly not after the exercise.
Afterwards-take time and make a habit of all the following things:
Take your Body weight with minimum of clothes
Recapitulate what misadventures you did yesterday with meals etc
Examine your feet (sloes with mirror)
Have a close look of your teeth, skin, nails, eyes
Plan your exercise and activity
Consider your days’ meal plan and provisions for any outdoor meals!
See that you have adequate and appropriate supply of your medicines
Make a mental chart of your days’ final schedule!
Look if any self monitoring is to be done with your glucometer
Look at your weight chart-identify trends
Measure your BP
Look at your blood glucose readings over the past 6-7 days
Attend to your feet, nails, skin, exercise etc at leisure on your weekly holiday
Track your doctors’ prescriptions, review your treatment plan, plan your next visit
Consult your diabetologist
Get an fasting and PP Blood Glucose done at your neighborhood lab and cross check with your glucometer,
Check if Lipids,Creatinine,TSH,HbA1c,Urine Protein/Albumin,SGPT/SGPT or any other test in the past which needs to be re-evaluated and revalidated-as per your doctors’advice