Your glucose meter score

[Guest guest]

Scheiner MS, CDE

Jun 5, 2011

A few months ago, I had the privilege of traveling to Australia to present

at a conference of athletes with diabetes <http://www.diabeteshealth.com/> .

During the meeting, prizes were awarded to everyone who scored exactly 5.5

mmol/L (99 mg/dL) on their glucose meter

<http://www.diabeteshealth.com/browse/products/meters/> . You should have

seen it! Anyone who measured close to 5.5 was testing again and again,

hoping for that magic number to pop up. Fingers were suffering, but the test

strip manufacturers were making out like bandits.

Most of us have a number that we consider " ideal. " Mine is 100 on the nose.

Any time I hit 100, I do a little celebratory dance that probably elicits

rain somewhere in the desert. The target that we choose is actually very

important in intensive diabetes management. Whenever you take mealtime

insulin <http://www.diabeteshealth.com/browse/medications/insulin/> and

make a " correction " dose adjustment for highs and lows, your target blood

<http://www.diabeteshealth.com/browse/monitoring/blood-sugar/> sugar comes

into play. Set a target that's too high, and you increase your risk for

short- and long-term health problems. Set a target that's too low, and you

set yourself up for frequent and potentially severe bouts of hypoglycemia

<http://www.diabeteshealth.com/browse/complications-and-care/low-blood-sugar

/> . Set a target that's a range instead of a number, and you're going to

increase the variability of your blood sugars.

So what is the best target?

Blood sugar targets, like most aspects of diabetes management, should be

individualized. Setting the right target is all about balancing risks and

benefits. We all know that tight control is a good thing, but we have to

balance it against the risk of hypoglycemia.

For most of my clients, I like to start with a target BG of 120 mg/dL (6.7

mmol/L) and then adjust in 10 - 20 mg/dL (.5 - 1 mmol/L) increments based on

the following individual risk factors:

Raise Target For:

+ Hypoglycemia

<http://www.diabeteshealth.com/browse/complications-and-care/hypoglycemia-un

awareness/> unawareness

+ History of severe lows

+ High-risk work

+ Unstable angina

+ Living alone

Lower Target For:

- Elevated A1c <http://www.diabeteshealth.com/browse/monitoring/a1c-test/>

- Pregnancy <http://www.diabeteshealth.com/browse/pregnancy/>

- Feeling unwell with modestly elevated BG

- Fighting complications or infection

- Use of CGM <http://www.diabeteshealth.com/browse/products/cgms/> with low

alert turned on

Sometimes, the decision might be influenced by several factors at one time.

We raise, lower, raise, lower, and wind up right back where we started. But

that's OK, as long as the target chosen represents a good balance between

benefit and risk.

In terms of using a target " range " (which is an option with many insulin

<http://www.diabeteshealth.com/browse/products/insulin-pumps/> pumps), my

recommendation is don't. When correcting to a range rather than to a

specific number, you increase the chances that your next reading will be too

high or too low. Ranges are for evaluating your control, not for determining

a correction dose.

For example, if you correct your highs down to 160 (9) and your lows up to

80 (4.5), you are less likely to be within the range of 80 - 160 (4.5 - 9)

the next time you check than if you corrected your highs and lows to exactly

120 (6.7). Using a sports analogy (which is about all I know), correcting to

a range is like an archer aiming for the outer edges of the target. But

correcting to an exact target number is like aiming for the bull's eye. It's

obvious who is going to win that contest.

So if you want to be on-target more often, give some serious thought to how

you set your blood sugar target. And when you hit yours exactly, do a little

dance. There are places that really need the rain.

Editor's Note: Scheiner is a Certified Diabetes Educator with a private

practice, Integrated Diabetes Services, near Philadelphia. He also serves as

" Dean " of Type-1 University, a web-based school of higher learning for

insulin users, offering live and prerecorded courses on a variety of topics.

and his staff provide diabetes management and education services via

phone and the Internet for children and adults worldwide.