Back to Blog

Self-monitoring of Blood Glucose (SMBG): Making it simple & actionable for PWD on basal insulin

    
For people with diabetes (PWD), initiating basal insulin can be a very scary and complicated process. As clinicians, we all try to help PWD prioritize self-management activities that are necessary to make therapy adjustments including basal insulin titration.

Many PWD are used to checking their blood glucose adding to the multitude of patient-generated health data (PGHD) that comes with living with diabetes. Unfortunately, many PWD are not always skilled or confident enough to use such data to adjust their therapy. With basal insulin, the fasting SMBG (FBG) results are needed to get to the right dose, but without the skills or confidence to use these results, the majority of PWD on basal insulin are never able to reach the optimal insulin dose for them.

Here are some simple considerations for SMBG when on basal insulin:

  1. When initiating basal insulin (starting at 10 units or 0.1 or 0.2 u/kg), PWD must be empowered to use their SMBG results to titrate up to 0.5-1.0 u/kg.
  2. Primarily, fasting SMBG (FBG) results are used to titrate basal insulin.
  3. A daily FBG is needed for effective basal insulin titration. Consistency is important.
  4. PWD may use the average of the last three FBG readings (for titration every 3-7 days) or only the last blood glucose (for titration every 1-2 days). Find a schedule that works for the individual.
  5. Basal insulin can be adjusted between one to eight units based on the FBG results and depending on the frequency of titration.
  6. When blood glucose is below target or when hypoglycemia occurs, basal insulin dose should be reduced (down-titration).
  7. At 0.5-1.0 unit/kg, a clinician may want to consider mealtime insulin and request additional SMBG. 
Empowering PWD with tools to use SMBG in basal insulin management allows for efficient titration and sets them up for ongoing success. Additionally, PWD can learn how to use PGHD such as SMBG to evaluate outcomes and modify treatments. Most importantly, SMBG empowers PWD to feel like blood glucose values are just numbers…numbers that they can self-manage.

Remember, how we communicate about blood glucose matters! Strengths-based language can improve motivation to act and do something with the data.

Here are few to consider:
  1. Instead of compliant/adherent, focus on facts, not judgement; and indicate: he/she is monitoring blood glucose daily.
  2. Instead of controlled/uncontrolled, use words that don’t judge or shame like, within range or within glycemic targets.
  3. Instead of normal, use words that don’t suggest that a PWD is somehow abnormal, like: in comparison to the guidelines. 

In the end, PGHD such as SMBG is a way to help PWD make health decisions that will not only improve their health outcomes but empower them to keep going. People can self-discover and develop the skills and confidence to be responsible for their own reaction to the data.

References

  1. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes - 2019. Diabetes Care 2019; 42(Suppl. 1)
  2. Riddle MC, Rosenstock J, Gerich J, et al: The treat-to-target trial: randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Diabetes Care 26:3080-6, 2003
  3. Gerstein HC, Yale JF, Harris SB, et al: A randomized trial of adding insulin glargine vs. avoidance of insulin in people with Type 2 diabetes on either no oral glucose-lowering agents or submaximal doses of metformin and/or sulphonylureas. The Canadian INSIGHT (Implementing New Strategies with Insulin Glargine for Hyperglycaemia Treatment) Study. Diabet Med 23:736-42, 2006
  4. Hermansen K, Davies M, Derezinski T, et al: A 26-week, randomized, parallel, treat-to-target trial comparing insulin detemir with NPH insulin as add-on therapy to oral glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetes Care 29:1269-74, 2006
  5. Zinman B, Philis-Tsimikas A, Cariou B: Insulin Degludec Versus Insulin Glargine in Insulin-Naive Patients with Type 2 Diabetes: A 1-year, randomized, treat-to-target trial (BEGIN Once Long). Diabetes Care 35:2264-2471, 2012
  6. Bolli GB, Riddle MC, Bergenstal RM, et al: EDITION 3: New insulin glargine 300 U/ml compared with glargine 100 U/ml in insulin-naive people with type 2 diabetes on oral glucose-lowering drugs: a randomized controlled trial. Diabetes Obes Metab 17:386-94, 2015
  7. Rosenstock J, Hollander P, Bhargava A, et al: Similar efficacy and safety of LY2963016 insulin glargine and insulin glargine (Lantus(R)) in patients with type 2 diabetes who were insulin-naive or previously treated with insulin glargine: a randomized, double-blind controlled trial (the ELEMENT 2 study). Diabetes Obes Metab 17:734-41, 2015
  8. Dickinson JK, et al: The Use of Language in Diabetes Care and Education; Jane Diabetes Care Dec 2017, 40 (12) 1790-1799