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Diabetes (I) – The importance of self-monitoring of blood glucose


Ms. Jessa Chow, Accredited Practising Dietitian (Australia)

Mr. Chu, a 70-year-old elderly asked, ‘can I not do finger pricks? There should not be much variation in my blood glucose level and I am feeling well.’ Similar to Mr. Chu, a lot of diabetic patients do not test their blood glucose levels on a regular basis. The importance of self-monitoring of blood glucose (SMBG) is often overlooked and finger prick is regarded as a painful and complex procedure.
 
Is it necessary for me to consult a dietitian? Following a rigid menu is difficult” many commented. Reluctance to consult dietitians is commonly seen because it is generally believed that a rigid diet with limited food choices will be prescribed.
 
As opposed to common perception, n, diet control for diabetes does not include a fixed menu which lists out food in each meal. The suggested advises by dietitians is individualized to patients according to a number of factors. With information such as age, height, weight, activity level and exercise pattern, the daily energy requirement can be estimated. Together with patient’s record on blood glucose levels at different times of the day, dietitians can then give specific suggestions on meal times, carbohydrate allowance for each meal, special arrangement for exercise, and so on.
 
Therefore, diabetics are encouraged to perform SMBG (including the record of fasting, pre-meal and 2-hour post-meal values) and write a detailed “food diary”, because these give an important information for dietitians to design an individualised meal plan.  
 
To increase the flexibility of diet, dietitians will educate patients on ‘carbohydrates counting’. This allows patients to make appropriate food choices and control carbohydrates intakes to avoid fluctuations in blood glucose level.
For example, 1 serve of carbohydrates (10 grams of carbohydrates) is equivalent to
-       1 round tablespoon of rice
-       1/3 bowl of cooked macaroni
-       1/2 bowl congee
-       1/2 slice of bread
-       1 small potato (egg-sized)
 
If Mr. Chu is allowed 5 serves of carbohydrates at dinner, he can choose between 5 round tablespoons of rice or 3 tablespooons of rice with 2 small egg sized potatoes. To control blood glucose level within a desirable range (fasting blood glucose level 4 – 6 mmol/L; 2-hour post meal blood glucose level less than 8 mmol/L), having consistent amount of carbohydrate at regular times is necessary.
 
Dietary management of diabetes requires the effort and commitment of patients. From now on, start a food and exercise diary”, and record the type and amount of food consumed as well as exercise type and frequency. In addition, monitor blood glucose level regularly as instructed by dietitians so that the effectiveness of diet therapy and exercise plan can be evaluated and revised as required. See below na example of “homework” by a diabetic.
 
Food and exercise diary:
 
Meal
Time
Place
Food and amount
Blood glucose level before meal
Blood glucose level 2 hours after meal
Note
Breakfast
8:00
Home
1 glass low fat milk
+ 2 slices toast
+ 1 pan-fried egg
5.6 (fasting)
7.2
 
Lunch
13:00
Chinese Restuarant
2 prawn dumplings
+ 1 siu mai /steamed dumplings with pork fillings
+ 1 barbequed pork bun
+ ½ bowl shredded pork noodles
/
5.1
 Walking 30 minutes
Afternoon tea
16:30
Home
1 apple
+ 1 pack saltine crackers
/
/
 
Dinner
20:00
Home
1 bowl rice
+ 3 taels pan-fried pork chop
+ 1 bowl stir-fry bok choy
+ 1 small orange
6.7
7.4
 
 
 
 
Translated by Ms. Joyce Lam, Accredited Practising Dietitian (Australia)