Self Monitoring of Blood Glucose

Information for people with Type 2 diabetes

Blood glucose (blood sugar) control in people with Type 2 diabetes is monitored closely, by the blood test which measures HbA1c. Your doctor or nurse will do a blood test  approximately every 6 months at your diabetic review to measure HbA1c. This test provides an indication of your long term blood glucose control. If there are any concerns, the test may be carried out more frequently and you will be given support to help you maintain good blood glucose control. This should include advice about diet and exercise, and may involve prescribing medication. 

What is self monitoring of blood glucose (SMBG)?

In some patients, it may be appropriate for them to test their blood sugar levels at home as well as having regular HbA1c tests. 
 
Previously, people with Type 2 diabetes were encouraged to check their blood glucose levels at home on a regular basis.  More recent evidence suggests however that for patients whose diabetes is either controlled with diet or who are on certain oral medicines, frequent testing of blood glucose is not necessary and may in fact increase levels of depression or anxiety in some patients. 
 
The National Institute for Health and Clinical Excellence (NICE) guidance on the Management of Type 2 diabetes (May 2009) does not support routine or frequent monitoring of blood glucose for patients whose diabetes is diet controlled or who are on oral glucose lowering medications. 
 
It may be however be appropriate to test in certain situations.
 

When is it appropriate for people with Type 2 diabetes to self test?

Frequent self-monitoring of blood glucose is an essential part of management for patients with diabetes who are treated with insulin. 
It is also recommended that people on certain tablets such as a sulphonylurea which may cause hypoglycaemia (low blood sugar) also test regularly (usually up to twice a week).   

It may be appropriate for some patients to self test when their diet or medication is being adjusted or during illness so that they can assess the impact of these changes on control of their blood sugar. Your doctor or nurse can advise.
 
An NHS Diabetes Working Group on ‘Self monitoring of blood glucose in non-insulin-treated Type 2 diabetes’ report published in December 2009 also concluded that self monitoring of blood glucose is not routinely recommended in patients who are not on insulin or on a sulphonylurea.
 
The PCT guidance on blood glucose testing supports both NICE and the Diabetes Working Group recommendations. A leaflet which provides recommendations for patients on frequency of blood glucose testing in Type 2 diabetes is available from GP practices in Cambridgeshire and from the PCT.