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How often should a diabetic check blood sugars?
Diabetic patients who are not using insulin should check blood sugar once or twice a day. Patients who take 3 or more injections of insulin should check blood sugars at least 4 times a day. We are going to talk about when and how often to check the blood sugars as this is a widespread question in my practice that I hear every day. Sometimes it more important when to check blood sugars rather than how often to check blood sugar.
Rightfully people ask how many times should I check blood sugar; because it hurts. Especially if you’re doing finger sticks that sucks. If you have a CGM like a Dexcom G6 or freestyle libre that is great but even then you sometimes have to do finger checks and most of the time people don’t even understand when to do finger checks when they’re wearing a CGM. On the other hand, if they are using a regular meter then that’s another story. Still, you have to understand how many times to check blood sugars as a diabetic because you don’t want to check too many times and you don’t want to check too few times.
Do you really have to check your blood sugar 7-10 times a day to know your blood sugar control?
Basically, we are going to start with the easiest patient example. So, basically, let’s talk about a patient who just got diagnosed with diabetes. As you can imagine they’re super nervous. They’re checking their blood sugar seven-eight times a day. Well, initially that may be exciting and you know if you’re worked up you wanna get this under control. That is great but eventually, you are going to burn out. So, there is an easier way to do this than just doing seven-eight times a day. Now, if you are really wanting to you know and still have an understanding of where your blood sugars are without doing eight times a day, do the scattered method. You scatter your blood sugar checks. While doing that make sure that it’s organized so your doctor and yourself can actually look at it and have an understanding.
For example, if you want to check your blood sugar twice a day, this is how you can organize; you can do one-day first thing in the morning fasting which is important. And then, the second blood sugar check could be an hour or two after breakfast. But make sure you’re consistent. Let’s say if you want to check one hour after breakfast. Keep doing that one hour after meals if you’re gonna do after lunch or after dinner etc. Make sure that it’s one hour after. Because, if you’re doing one hour one day and two hours after another day then it becomes confusing. So, let’s say one day you do it for breakfast on Monday. On Tuesday you can do a blood sugar check before lunch and after lunch one hour after I mean. Wednesday it’s the same thing before and after. You just change the meal times but still stick to the two times a day. That way you have an understanding of what your blood sugars are before and after breakfast before and after lunch before and after dinner etc.
What a lot of people do they check their blood sugar first in the morning and then before bedtime every day? They keep doing the same thing over and over again. If you know it is especially similar in the mornings, meaning, similarly high or similarly low what is the point of repetition while you can discover your other blood sugars at other times of the day?
Some people say; oh my blood sugar was 180 yesterday and today is 160. Not a big deal. It is still high of course. And, what you eat and what you do as physical activity etc everything affects it. But the bottom line, you’re running overall high so there is no point of rediscovering or getting hung up on 160 vs 165 vs 175. Don’t worry about it. If it is high it needs to be fixed. Move on to see where the other problems are.
What some people think that 160 blood sugar sounds okay. They say I can live with that. However, then when they check their blood sugar after eating after breakfast they realize that they go sometimes up to 250. They would not know that unless they checked it.
The scattered method I think that’s the best way to do it especially if you have limited amount of strips or if you cannot afford strips or just you just hate your pricking your fingers.
Try to be wise and try the scattered matter method especially if you’re new to diabetes and do not want to burn out. If you are not so new and you’re on certain medications or your diet managed and you’re doing well. That is a different story.
How many times do you really check your blood sugars at the early stages of diabetes?
You don’t really have to check too many times. If your blood sugars are not very uncontrolledMeaning your A1c is below 7%, you can check it once a day in the mornings, just to keep an eye on your blood sugars overall. As we mentioned occasionally you can check it after meals to see where your blood sugars are. You can do that occasionally after meals. Let’s say you think that you had too much carbs, and you want to check. This will help you understand how food affects you and so forth. For example,if your overall well controlled and you’re waking up with you know say 100 Or 110 and then occasionally you check after meals and you never go more than 160 170 after meals then you’re pretty well controlled.
What is a well-controlled diabetes blood sugar?
For some people, these blood sugars we talked about just above may not sound like well-controlled but I’m talking about general purposes. Because our goal for diabetes depends on the patient. We individualize goals. Sometimes we are very strict with patients. Let’s say a pregnant patient. We want to keep them less than 90 in the morning. A pregnant woman vs an 80-year-old frail woman does not have the same blood sugar goals. So, we don’t tell An 80-year-old woman you have to wake up below 90 because we know that they’re going to be at risk of dropping their blood sugar in that age too low. It can be very hard on them and it can actually be very dangerous. So, what we try to do here trying to manage risk based on the patient so that’s why your doctor should give you the Individual goals. You should know exactly what your goal should be . So, what your personal goal should be between you and your physician
Can I stop taking your blood sugars if they are consistently normal?
Some people do that and they stopped checking their blood sugars. And the next thing they know that they’re in the 200s again. You don’t want to do that either. So don’t be too obsessed, but also don’t be too loose. Just find a middle ground. Yet I would suggest that break the habit; if you’re checking it every morning and if it is every morning 120 just stop it. Because it’s not changing. You’re not really discovering anything new. Then your diet is not changing. When you check it at different times a couple of times a week will give you a general idea overall.
How many times a day check my blood sugars on insulin?
Of course, if you’re on insulin that’s a little different story. So if somebody is on basal insulin, in this case, I would suggest checking the blood sugar before you go to bed and then before you wake up. The reason for that is especially initially during the titration stage. Because we don’t exactly know how much insulin you will need. So, we start you from somewhere and we titrate you to the goal. In that stage, you always have to want to check the blood sugar at night and in the morning.
What a lot of people don’t understand is why we’re doing this. The reason is that the long-acting insulin is designed to keep your blood sugar stable overnight and during the day as well. Your liver is constantly making blood sugar. That is regulated by insulin and insulin sensitivity. When your insulin resistance especially when you have diabetes, you know that your liver does not realize that there’s some insulin. So the liver keeps making too much sugar. In order to overcome the insulin resistance, if you’re not able to exercise, have good dieting, the insulin you are making may not be enough. Just simply diet and exercise sometimes is not enough either. In those cases, we start basal insulin just to keep the blood sugar stable.
Why is my blood sugar high in the morning?
Without enough insulin or too much insulin resistance is why a lot of people wake up with high blood sugar in the morning. Just because the liver makes sugar especially after 4 o clock in the morning. At that time the growth hormone kicks in and all that other stress hormones get in. That’s really depressing for a lot of people so what we do is we just put basal insulin and that way we really are we are trying to do keep the bedtime blood sugar and the morning blood sugar pretty much similar. There are herbal remedies to do that as well. So insulin is not the only way. Also, metformin and Actos are other drugs that can help morning blood sugars.
Why is my blood sugars up and down in the mornings?
You will never wake up with the same blood sugar. So forget about you trying to keep your blood sugar like on a flat line. That simply doesn’t happen. You don’t see a flat line in any human body. The moments you see a flat line means you are dead. Anyway, everything constantly is changing. Everything affects your blood sugar. So, it’s not like a heart rate. Even your heart rate gets up and down a little bit daily. A normal person wakes up around eighty or ninety blood sugar, but when you’re diabetic you know there’s a lot of factors playing into it. If you are waking up with a blood sugar of let’s say less than 120 that’s great. But we don’t want to start at 200 at nighttime and wake up at 120 in the morning. That is not necessarily always good either when you are on insulin. So we want to make sure that your blood sugar is similar overnight on basal insulin.
What a lot of people do wrong is that they try to give too much basal insulin to try to control morning numbers. Well, that’s a problem. Because we don’t want you to go down like this overnight. That’s very dangerous. So, if you want to keep your blood sugar very stable when you’re sleeping you want to keep it as straight as possible. Now if there is a 20-30 plus-minus range is ok. This difference is very acceptable. Because that’s not going to put you to danger zone.
Let’s say you go to bed with 120. You know if you wake up with 90 that’s not a big deal. But, if your blood sugars are typically dropping a hundred points overnight because of the insulin then you are putting yourself at a significant risk of going very low down to 20 in this example with the insulin. So the goal of the basal insulin again is to keep the blood sugar stable overnight. That’s why I recommend checking blood sugar at nighttime and in the morning which is extremely important. Once you’re stable and you know you’re a pretty regular person and nothing is really changing in your life, then you don’t have to keep repeating that cycle. In that case, you can maybe just check your blood sugar at nighttime to make sure it’s not too low before you go to bed.
People are really scared of insulin because most of the time they are prescribed too much insulin or patients sometimes do their own thing based on their own ideas. For example, they just increase insulin thinking that it’s going to result in better blood sugar well. That’s true but you know you have to be careful. Definitely consult with your diabetes doctor.
At SugarMDs we basically monitor you all the time. We have the cellular systems ready to go transferring data electronically to us. So if you are going to bed with 200 and waking up with the 70 we immediately realize it. And we call you. We see what’s going on. Of course, most of our patients don’t get to that stage because we never over insulinize our patients. We have a system where we can remotely monitor you without even you having to call us. We will call you to make sure everything is staying stable and straight.
Back to how often to check blood sugars. Check at bedtime and in the morning especially in the beginning. You can still check your blood sugars occasionally after meals so you know it. It doesn’t have to be all the time. Let’s say your doctor may say ok we now controlled your blood sugars. You are waking up less than 120-110, and you’re consistent with your morning and nighttime blood sugar checks. They are not horrible. But if you’re waking up with 120 and your blood sugars climbing up to 180-200 by the time you go to bed you know what we need to address this.
Blood sugar spikes after eating?
The blood sugar spikes after you eat can be damaging. So what we typically ask patients is if their fasting blood sugars are not bad; we ask them about their blood sugars after they eat. I tell them to check blood sugars one day after breakfast, one day after lunch, one day after dinner, etc. Again we try not to do too many finger sticks. We try to keep it to a minimum. So, I tell them to check so I see whether blood sugar spikes more than 180-200 after certain meals. That’s a red flag. We try to adjust the diet, of course, reduce the carbs or exercise more, etc. If they can, great. If they cannot, then we have to do something about this. We have a lot of great medications or herbal approaches as well that help control the blood sugar spikes after meals. Again. not everybody is the same. Some people do great with diet and exercise but depending on the disease state status. Type 1 diabetics, for example, have to take insulin with meals some patients would have type one and a half (1.5) diabetes. They have to take insulin anyhow in later stages. Some people may think that if you stop eating sugar your diabetes will be fixed. Well, that’s not the case always. I will say 50% of people tops, that’s generally true at the beginning stages of type 2 diabetes. In my practice, I see a lot of complicated cases. Those cases that people discuss on YouTube and other places are simple new diabetics. They just stop eating carbs and they think they are fixed for good. But diabetes is not a disease like that. It’s a very philosophical disease. Most people don’t understand what it is. What it really entails etc. Everybody thinks it’s just a sugar problem. It’s not.
The bottom line is if you’re checking your blood sugars twice a day you can stagger it. If you’re on basal insulin, check one time a day at night and in the morning to make sure they’re stable. Once your fasting blood sugars are stable we look at your blood sugars after meals again by checking your blood sugars after certain meals.
Who needs to check their blood sugar four or more times?
Those are the people who would really take insulin for three-four times a day with their meals and bedtime. The one basal insulin and three mealtimes. For type 1 diabetics they have or advanced type 2 diabetics do multiple injections a day.
The reason they have to do multiple injections is that they really need to know their blood sugar before they take insulin. Because the fast-acting insulins actually drop your blood sugar very rapidly. So there are two reasons of taking the rapid-acting insulin. One is for correction of high blood sugar and the second is for the food, for the carbohydrates of course. For example, if you’re like 200 before you eat, you need to know that so that you can take a little bit of extra insulin to correct a 200 number. The same thing applies if your blood sugars are down to 70. You may want to take a couple of units off of your regular schedules so that you avoid low blood sugar.
Also, monitoring also helps you understand overall how you are doing. Let’s say you check your blood sugar before breakfast one day and then the second day you know after you check it before lunch. Let’s say your blood sugar goes up quite a bit every time after you eat you have to breakfast. By lunchtime, BG should be down but you’re still at 160-170 range by lunchtime. Then you know that you actually need to take more insulin for your breakfast next time. Checking blood sugars before meals on insulin helps to adjust your insulin and give your doctor some data to have him or her understand what’s going on with your blood sugars.
Why are my blood sugars up and down all the time?
If your blood sugars are all over the place, then maybe you need to pay attention to your diet a little bit more to try to fix your consistency or carbohydrate counting. If you’re taking let’s say ten units of insulin for every breakfast. Your blood sugar one day drops down to 90 by lunchtime and another day goes to 190. That means that what you’re eating probably is very different which is giving different results although you take the same amount of insulin. So, you have to understand the consistency of your eating.
In my practice what I really love about is those cellular meters. Because every time patients check their blood sugar it comes to me. So I don’t have to really beg for the numbers. Excuses just used to drive me crazy but now we make lives of patients with diabetes easy.
Are fingersticks necessary on Dexcom G6 or freestyle libre CGM?
Let’s talk about when to check your blood sugars when you’re using a CGM like Dexcom G6 or libre. The CGM companies like Dexcom or freestyle Libre or Medtronic, they all advertise no finger stick. No finger sticks are true to a point but they don’t really tell you downsides of the products they sell. Here’s what happens if you’re on CGM: Any CGM is somewhat delayed when the blood sugars are changing rapidly. If you check the fingerstick you will see that if your blood sugars are changing rapidly your Dexcom is not going to be true. One typical example that a lot of people do wrong is this.
Dexcom G6 will show that their blood sugar is low and it’s true. It’s typically low when it says so. It’s generally correct although freestyle libre has not been the most correct CGM,. Anyhow, then you eat something, and then Dexcom will keep it showing still low. They end up to keep eating more and more and next, you see blood sugar is 300.
The reason for that is there is a delay so you cannot really rely on CGM when you have low blood sugar to fix that low Bg. So what you should do is you eat something 15-20 grams of carbohydrates like simple carbs candy etc and then you check it in 15-20 minutes with the finger stick then your finger stick may tell your blood sugar is 120. That is good. Dexcom may still say your blood sugar is 75. Dexcom or libre shows the trends which is always a good thing to know that your blood sugar is now rising or going down based on what you have done but the exact numbers are not gonna be true when your blood sugar is going really high or really low rapidly.
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Remember, next time you ask how often should a diabetic check blood sugars, now you know. Check blood sugars 1-4 times a day. That is enough in most cases. Do not do too many or too few. Ask your doctor if you are still not sure after reading this article in its entirety.
Ahmet Ergin, MD, FACE, CDCES, ECNU