Richard Croft Diabetes Lead Berkshire West

The impact of a 1% reduction in HbA1c

((There is no correlation at all!)

Think: why is he testing? What will he do with the result? What will YOU do with the result?

 Diabetics who use insulin – Type 1, and Type 2 who use insulin  Women with gestational diabetes  Some patients who use sulphonylureas (eg gliclazide), especially if they drive  Other patients with intercurrent illness

 Everybody else!!

To detect hypo- and hyper-glycaemia in diabetics who use insulin (and SUs) To help patients prevent immediate serious illness (hypoglycaemic attacks and DKA) As part of the long-term management of diabetes to maintain good control and prevent micro- and macro- vascular complications

 In Type 1 DM ◦ Before meals 4-7mmol/l ◦ 2hrs after meals < 9mmol/l  In Type 2 DM ◦ Before meals4-7mmol/l ◦ 2 hrs after meals< 8.5mmol/l

Twice daily insulin therapy – Test 2-3x day, varying testing times between fasting, premeal and postmeal to identify trends Intensive insulin therapy (basal bolus) – Monitor 2-4x day normally – Monitor at least 4x day if they alter doses at mealtimes More frequent testing during intercurrent illness

Twice daily insulin regime – Test 1-2x day varying times between fasting, premeal and postmeal Intensive insulin therapy (basal bolus) – Monitor 2-4x day normally – Monitor at least 4x day if they alter doses at mealtimes Once daily insulin (basal regime) – Test fasting BG once daily during initiation, can then be reduced to 1-2x week)

 Naseem is going to talk some more about testing in Type 1 diabetes  We are going to introduce carbohydrate counting as a means of improving control in people with Type 1, and a very smart device to help patients calculate their correct dose of insulin