by Philip Eager

Created on: June 19, 2007

Empowering Your Patients to Tighter Control

"I Know what to do I just don't do it."

Who hasn't ever fallen into this common trap? When it comes to home blood sugar monitoring the patient who just fails to test his or her blood sugar as recommended is labeled "non-compliant". What interventions or steps the doctor or diabetes educator can take to help motivate this sort of patient to check their blood sugar with more regularity is an important part of assisting patients to get the benefits of tighter blood sugar control.

Not Everyone Is a Candidate for Tighter Control

Before embarking on promoting tighter control and a routine of 3 or more a day blood glucose monitoring it is important to decide if this is really in the best interest of the patient who is hearing your recommendation. Is the patient really motivated to follow this tight intensive management? Do they understand the benefits and risks? You might survey their knowledge.

Have you taken the time to educate the patient about the Diabetes Control and Complications Trial (DCCT)? Make sure they understand it.

I recommend both talking to them and testing them to make sure they understand the importance of good blood sugar control and their role in it.

It is important to ask the patient in both written and verbal form if they agree with this and also to get their signature on a "letter of agreement"

that spells out the need to monitor blood sugars at least 3-4 times a day and when to check their blood sugars, including testing at 3AM at least twice a month, if necessary. This will weed out people who clearly are not ready to embark on the path to tighter control.

Persons who have a history of severe hypoglycemia or no sensation of hypoglycemia may not be candidates for intensive blood glucose management. Children under 13 and senior citizens also need to be closely evaluated before being put on an intensive program.

Determining if someone is a candidate for regular blood sugar monitoring

To help you determine who is a reliable candidate for home blood glucose monitoring it is helpful to assess the patients level of motivation by having them rate themselves on the following type questions:

On a scale of 1 being least interested to 5 most interested rate yourself on the following items:

1. How interested are you in attaining a near normal HbA1c (6.0 - 7.0)?___.

2. How interested are you in checking your sugar 4x or more a day?___.

3. How interested are you in maintaining records of your blood sugar?___.

4. How

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