Self-Monitoring of Blood Glucose (SMBG) Testing
Self-monitoring of blood glucose or SMBG, is the process by which people with diabetes measure (or test) their blood glucose (also known as blood sugar), on a regular basis. Depending on the type of diabetes, medications used in its treatment, and other patient specific factors, blood glucose may be tested multiples times each day, or may be tested sporadically.
Patient with Type 1 Diabetes, who control their blood glucose levels with insulin commonly test up to 7 times daily or more and use SMBG as a tool to guide their insulin dosing. Patients with Type 2 Diabetes, who are using insulin to manage their blood glucose, often test on a similar pattern to people with Type 1 Diabetes. However, patients with Type 2 Diabetes using other medications or non-pharmacological strategies to manage their blood glucose may test only a few times daily or weekly, or may not test at all. The need for blood glucose testing depends on the glycemic control of each patient, and the frequency of SMBG is typically recommended by a patient’s doctor or pharmacist.
There is a general consensus amongst practitioners that patients (Type 1 or Type 2) using insulin should be testing their own blood glucose 3 or more times per day, however there is disagreement as to the recommended frequency in patients not using insulin. While this debate goes beyond the scope of this resource, the most recent Canadian recommendations have been summarized below.
Patient with Type 1 Diabetes, who control their blood glucose levels with insulin commonly test up to 7 times daily or more and use SMBG as a tool to guide their insulin dosing. Patients with Type 2 Diabetes, who are using insulin to manage their blood glucose, often test on a similar pattern to people with Type 1 Diabetes. However, patients with Type 2 Diabetes using other medications or non-pharmacological strategies to manage their blood glucose may test only a few times daily or weekly, or may not test at all. The need for blood glucose testing depends on the glycemic control of each patient, and the frequency of SMBG is typically recommended by a patient’s doctor or pharmacist.
There is a general consensus amongst practitioners that patients (Type 1 or Type 2) using insulin should be testing their own blood glucose 3 or more times per day, however there is disagreement as to the recommended frequency in patients not using insulin. While this debate goes beyond the scope of this resource, the most recent Canadian recommendations have been summarized below.
Canadian Diabetes Association (CDA) Guidelines - 2008
Summary of Relevant SMBG Recommendations
- Patients using insulin should use SMBG at least 3 times per day & should test both before and after meals
- Patients with Type 2 Diabetes using once daily insulin products combined with oral medications to manage blood glucose should test at least once daily at variable times
- Patients using oral medications or lifestyle strategies to manage their blood glucose should be considered individually with respect to test frequency & should test both before and after meals
- More frequent testing should be used in any diabetic patient to make treatment adjustments and avoid hypoglycemia
Canadian Agency for Drugs and Technology in Health (CADTH) Optimal Use Project on SMBG - 2009
Summary of Relevant SMBG Recommendations
- Diabetic patients using basal and bolus insulin regimens should have individualized recommendations for SMBG testing frequency
- Adult Type 2 Diabetics using once daily basal insulin should have individualized recommendations for SMBG testing frequency but should not need more than 14 tests per week
- Most adult Type 2 Diabetics using only oral medications or dietary strategies to manage their blood glucose do not need routine SMBG
- Periodic testing in diabetic patients not using routine SMBG may be needed in specific situations and should be linked to a specific action.
- Situations Include: unstable blood glucose, acute illness, medication changes, risk of hypoglycemia, pregnancy, activities where hypoglycemia poses danger
- Specific Actions Include: Preventing or managing hypoglycemia, self-directed dosage adjustment
SMBG in People with Type 2 Diabetes: CDA Briefing Document for Health Care Providers - 2011
Summarized CDA Comments in Response to the COMPUS Recommendations Regarding Type 2 Diabetes
- SMBG should not be considered an intervention but a tool to assess interventions
- Recommendations for oral antihyperglycemics should be individualized based on their risk of hyperglycemia
- The recommended maximum SMBG testing frequency in adult Type 2 Diabetics using insulin is 14 per week but that the frequency should be individualized
- Patients at risk for hypoglycemia may benefit from SMBG testing more than 14 times per week
- Routine SMBG testing is not recommended in adults with Type 2 Diabetes using only oral medications or non-medication strategies to control their blood glucose Patients using insulin secretagogues may benefit from routine SMBG testing
For more information please consult the individual resources below:
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes. 2008;32(suppl 1):S1-S201.
Canadian Agency for Drugs and Technology in Health. Optimal Use Project: Self-Monitoring of Blood Glucose. Available at: http://www.cadth.ca/en/products/optimal-use/self-monitoring. Accessed March 2, 2013.
Miller DM, Beard L, Cheng A, et al. Self-Monitoring of Blood Glucose in People with Type 2 Diabetes: Canadian Diabetes Association Briefing Document for Healthcare Providers. Can J Diabetes. 2011;35(4): 317-319.
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes. 2008;32(suppl 1):S1-S201.
Canadian Agency for Drugs and Technology in Health. Optimal Use Project: Self-Monitoring of Blood Glucose. Available at: http://www.cadth.ca/en/products/optimal-use/self-monitoring. Accessed March 2, 2013.
Miller DM, Beard L, Cheng A, et al. Self-Monitoring of Blood Glucose in People with Type 2 Diabetes: Canadian Diabetes Association Briefing Document for Healthcare Providers. Can J Diabetes. 2011;35(4): 317-319.