Most of the time we rely on a fasting value or a few values taken over a period of days or weeks, along with an HbA1c (a three month average of our blood glucose) to decide the course of treatment. These do not factor in variations in our blood glucose within each day. Devices do that, says Dr Ambrish Mithal, Chairman of Endocrinology and Diabetes, Max glucose monitorMost methods measure the glucose level in the interstitial fluid (the fluid between our cells) rather than the blood (Source: Freepik)
The young woman sitting across the table was perplexed and angry. “Why is my diabetes uncontrolled doctor? My fasting sugar value is 110 mg/dl, and after breakfast it never exceeds 170 mg/dl. I take all my medicines regularly. Why is my HbA1c (three-month average) invariably around eight per cent? How do I reach my target of seven per cent?”
After some discussion I managed to convince her to attach a continuous glucose monitor to her body, so that we could unravel the mystery of her high HbA1c. We had the answer next week. The monitor readings showed that her sugar began to rise late in the evening and returned to normalcy only by early morning. The conventional method of testing fasting and post prandial blood sugar was missing several hours of high blood glucose. A modification of her evening snack and adjustment of medication ensured that we were able to rectify her problem soon.
Many years ago, the legendary Elliott Joslin said that the aim of treating diabetes is to keep the blood glucose as close to normal as possible. Our blood glucose level is a widely varying parameter. However, most of the time we rely on a fasting value or a few values taken over a period of days or weeks, along with an HbA1c (a three month average of our blood glucose) to decide the course of treatment. Such estimates are at best crude as they do not factor in variations in our blood glucose within each day. The common way of obtaining blood glucose values during the day is by finger-prick testing using glucose meters. While these devices have greatly enhanced our ability to monitor and manage diabetes, they involve finger pricks, which can be uncomfortable. There is also a limit to the number of times one can check. There have been numerous attempts, therefore, to develop technology that will be able to monitor glucose on a continuous basis. This approach has met with success in recent years, and continuous glucose monitoring systems (CGMs) are now widely used.
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