Some of my older patients with long-standing insulin-treated diabetes tell me how, before capillary blood glucose monitoring was available, they measured their urine glucose concentration in test tubes containing several drops of urine, tap water and a Clinitest tablet. A blue reaction signified no glucose, while various shades of orange indicated variable concentrations of urine glucose. How they were meant to interpret the result or adjust their insulin based on this is anyone’s guess.
The latest NICE guidance on the management of type 1 diabetes recommends that people should be supported to test up to 10 times daily (NICE, 2015). Continuous glucose monitoring systems are advised for adults with type 1 diabetes who are willing to commit to using them at least 70% of the time and have recurrent problems with either hypo- or hyperglycaemia.
The NICE guidance was written before the release of Abbott’s flash glucose monitoring system, in which an easily applied glucose sensor lasting 2 weeks measures tissue glucose levels every few minutes and the results can be transmitted via Bluetooth to a hand-held device. The study by Bolinder and colleagues in The Lancet (summarised alongside) shows that this technology allows people with well-controlled type 1 diabetes to spend less time in hypoglycaemia.
From a patient perspective, flash glucose monitoring is very popular, even though it is not available on prescription in the UK. However, healthcare professionals are still trying to catch up. In the real world, stacking insulin (giving repeated doses of short-acting insulin in response to high blood glucose) is both very tempting and likely to result in hypoglycaemia. Good-quality research is required to help us make the best use of this impressive new technology; otherwise, users may find it as helpful as an orange urine test.
To read the article summaries, please download the PDF
Vinod Patel highlights the growing evidence base that lifestyle interventions are effective, and encourages persistence even though they can be difficult.
25 May 2023