Rationale:

• Recurrent hyperglycemia and/or hypoglycemia can be prevented if capillary blood glucose is followed routinely with the institution of corrective management.
• Urine testing of glucose level does not reflect the current glycemic status and should not be recommended for insulin adjustment.
• See figure Sick Day Guidelines and Insulin Adjustment.

Evidence:

• In a study to determine the effects of diabetes education, instructing patients to use urine testing to adjust insulin has been shown to be ineffective in reducing HbA_1c (140); however, education designed to teach patients how to recognize their hypoglycemic symptoms resulted in a reversal of hypoglycemic unawareness (99).

Comments:

• Keep in mind that several blood glucose meters are available for use.
• Continuous glucose monitoring may be more appropriate than self monitoring in some patients (141). However, a randomized, controlled trial has shown that continuous glucose monitoring was no better than self-monitoring with regard to glycemic control or hypoglycemia (142).
• An FDA alert stated concerns regarding falsely elevated glucose readings in patients who receive parenteral nutrition that contains maltose or galactose, and peritoneal dialysis solutions that contain icodextrin as well as xylose or galactose. This is limited to glucose meters that depend on GDH-PQQ (glucose dehydrogenase pyrroloquinoline quinone) reagent systems. GDH-NAD (glucose dehydrogenase nicotine adenine dinucleotide) utilizing glucose oxidase and glucose hexokinase can distinguish between glucose and other sugars.