Q: Some of my patients check their blood sugar a few times a week, some test daily, and others test multiple times per day. How often should my patients check their blood sugars, and what should their levels be?

Blood sugar testing is an important part of diabetes self-management. The information gleaned from testing is used by the patient and provider to help guide treatment decisions, prevent acute complications like hypoglycemia or hyperglycemia, and prevent or delay the long-term complications of diabetes. However, how frequently a patient should test will depend on a number of factors.

Blood sugar testing frequency should be individualized. based on the patient's preferences, resources, and clinical needs. The American Diabetes Association [ADA] (2014) recommends that patients who take insulin multiple times per day check their blood glucose before meals, occasionally after meals, at bedtime, before exercise, when they suspect low blood glucose, after treating low blood glucose until they return to their target range, and before engaging in any critical tasks such as driving. Patients who take noninsulin medications or manage their diabetes with diet and exercise alone may be able to test once per day or even a couple of times per week.

You can help your patients understand the value of blood sugar testing and reinforce the testing frequency that was agreed on between the patient and the healthcare provider. You should periodically evaluate your patients' testing technique, provide ongoing instruction, review the blood sugar results with your patients, and how to use the data to adjust therapy (ADA, 2014). When reviewing blood sugar results with your patient, assess their understanding of how food, exercise, and medications affect blood sugar results and for results that are outside of the desired range, discuss potential solutions.

The target blood sugar will also vary from patient to patient. The patient and provider should agree on a target blood sugar range based on the patient's individualized needs. Several factors that should be considered when establishing a blood sugar target include the age of the patient, the type and duration of diabetes, risk of hypoglycemia, and the presence of other conditions such as pregnancy, diabetes complications, or other comorbidities.

For many patients, a target plasma blood sugar range of 70 to 130 mg/dL before meals and <180 mg/dL 2 hours after a meal is reasonable. These values approximate with an A1C level (the average blood sugar over the past 120 days) of approximately 7%. Studies have shown that lowering A1C to 7% or below reduces microvascular complications of diabetes and is associated with long-term reduction in macrovascular disease. For this reason, providers generally recommend an A1C goal of 7% for many nonpregnant adults (ADA, 2014).

A more stringent A1C goal, such as 6.5%, may be reasonable for some patients if it can be achieved without significant hypoglycemia. A goal of 6.5% may be considered for patients with short duration of diabetes, long life expectancy, and no significant cardiovascular disease (ADA, 2014). However, higher A1C goals such as 8% may be appropriate for patients with advanced complications, a history of severe hypoglycemia, limited life expectancy, or extensive comorbid conditions (ADA, 2014).

Blood sugar testing is an important part of diabetes self-management. You play an integral role in helping patients maximize their blood sugar control by providing ongoing education and support.

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