Monitoring

Acute monitoring of blood glucose

Recheck the patient's blood glucose after 10-15 minutes and repeat administration of intravenous dextrose/oral glucose until the hypoglycemia has resolved (i.e., repeat administration if blood glucose remains <70 mg/dL [<3.9 mmol/L]).​[1][3][106]

Long-term monitoring

Clinicians should assess any episodes of hypoglycemia (both confirmed and suspected) and the possibility of impaired awareness of hypoglycemia at each patient visit.​[1][3][4]​​​​ For more information on impaired awareness of hypoglycemia, see Complications.

Monitoring of blood glucose is key for all patients with type 1 diabetes (and, in practice, any child being treated with insulin).[2][3][4]​​​​​ In particular, patients should monitor their blood glucose at times of particular risk of hypoglycemia, such as during sleep or prior to exercise.[1] In children, monitoring of blood glucose overnight is particularly important if they have additional risk factors for nocturnal hypoglycemia, such as younger age, lower HbA1c levels, and previous hypoglycemia associated with exercise.[1][124]​​​​ A child or young person having recurrent episodes of hypoglycemia should have increased input from their diabetes team.[70]

Blood glucose monitoring is recommended in adult patients with type 2 diabetes who:[76]​​

  • Have had prior hypoglycemic episodes

  • Are taking insulin[3][75]​​

  • Drive or operate machinery and use oral medications that increase the patient's risk of hypoglycemia

  • Are pregnant, or planning to become pregnant.

Hypoglycemia risk should be considered when setting HbA1c targets for patients with type 2 diabetes, as targets may need to be relaxed if they have experienced severe hypoglycemic episodes or have reduced hypoglycemic awareness.[72]

Continuous glucose monitoring (CGM) is the preferred technique to monitor blood glucose for most patients.[3][4][17][75]​​​​ Patients using CGM and their family or caregivers should have ongoing education and support in using their device and be encouraged to use it continuously.[70]​ Self-monitoring of blood glucose (SMBG) is an alternative.[3][4][125]​​​​

  • CGM has become increasingly available and is the preferred method of monitoring blood glucose for patients with diabetes who are being treated with insulin, particularly if they are receiving multiple daily injections of insulin or using an insulin pump.[4][17][70]​​[72]​​​​ CGM is also preferred over SMBG in patients with type 2 diabetes who are at risk of or have recurrent hypoglycemia (e.g., those taking sulfonylureas or those with impaired hypoglycemia awareness)[4][17][72]​​[125]​​​ In patients treated with insulin, real-time CGM resulted in better glycemic control and lower rates of hypoglycemia and emergency department visits or hospitalization for hypoglycemia compared with SMBG.[4][125][126]​​​​ The American Association of Clinical Endocrinology strongly recommends CGM for all patients with diabetes treated with intensive insulin therapy, defined as three or more injections of insulin per day or the use of an insulin pump.[75] In a multi-site registry of 3553 pediatric patients with type 1 diabetes, the introduction of CGM was associated with fewer patients experiencing severe hypoglycemia over a 1-year observation period.[127]​ Be aware, however, that inpatient CGM use is not currently approved by the US Food and Drug Administration (FDA), but does currently have enforcement discretion (i.e., for patients who are at high risk of hypoglycemia).[17]

  • Even though CGM is the preferred option for most patients, SMBG may still be necessary to validate or confirm blood glucose levels obtained from CGM (such as during exercise, when CGM readings become less accurate).[17][37]​

For more information on general monitoring of diabetes, see the following topics: Type 1 diabetes, Type 2 diabetes in adults, and Type 2 diabetes in children.

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