Diabetes Health

Importance of SMBG during the COVID-19 pandemic

Dr Vijay Viswanathan explains how people with Diabetes can effectively manage their blood sugar levels and stay healthy and safe.

The COVID-19 infection has caused lesser deaths in India than in many other countries. However among people who developed serious disease, uncontrolled Diabetes was one of the important factors. Uncontrolled Diabetes prevents a person with COVID-19 infection from mounting the right type of immunity against the virus.

The American Diabetes Association website states that people with Diabetes are more likely to experience severe symptoms and complications when infected with a virus. If Diabetes is well-managed, the risk of getting severely sick from COVID-19 is about the same as the general population.

When people with Diabetes do not manage their Diabetes well and experience fluctuating blood sugars, they are generally at risk for a number of Diabetes-related complications. This is why it is of paramount importance that people with Diabetes effectively manage their blood sugar levels.

In the research paper we recently published in the peer reviewed journal Diabetes and Metabolic Syndrome: Clinical Research and Reviews, we did an online survey of how people with Diabetes were coping with their Diabetes during the lockdown. A small per cent of people who were using only insulin would check their blood sugar levels regularly. But on the whole, the percentage of people who would self-monitor their blood sugar levels regularly was very less – only 28 per cent – during the lockdown. The positive point was that most people said that they were able to follow their diet properly because they were always at home and were also able to keep themselves physically active.

Importance of SMBG

Self-monitoring of blood sugar levels (SMBG) is crucial for improved health parameters and as it helps people take control of their Diabetes and achieve target blood glucose levels. SMBG data proves invaluable to monitor blood sugar levels and fine tune the Diabetes management regimen – diet, physical activity, medication or using more or less insulin.

The best way to monitor blood sugar for people with Type 1 or Type 2 Diabetes and women with Gestational Diabetes Mellitus is to use a glucose monitor at home and check blood sugar at different times of the day, both before and after the meals.

People with Diabetes on oral anti-diabetic agents could check less frequently once or twice a week. People with Diabetes on insulin injections will require more frequent monitoring – at least at different times on different days – fasting, before meals, post prandial and before bed time. This frequency changes from individual to individual. This is to know the pattern of rise and fall of the blood sugar level. This will help the physician to adjust the insulin doses in such a way that the pre-meal blood sugar levels are kept around 110 or 120 mg/dL and post meal blood sugar levels between 160-180 mg/dL.

Note: It is advisable to consult your doctor to determine a personalised SMBG schedule to optimise your Diabetes management.

COVID-19 precautions for people with Diabetes

People with Diabetes especially those above 60 years and children with Type 1 Diabetes and those with chronic kidney disease or cardiac complications should take more care to prevent a COVID-19 infection by avoiding crowded places and by maintaining all the good practices like frequent hand washing, physical distancing etc. It is important to exercise indoors every day for at least 30 minutes in a day.

Simple exercises like stretching, walking and Yoga can help maintain ideal blood sugar levels. Eating a healthy diet is important. Eat cucumber, apples and oranges or a healthy snack or a health drink in between meals to avoid eating high calorie and processed foods. Quality sleep for at least seven hours every night is necessary to better manage Diabetes.

Important: It is important to immediately consult your physicians through tele-medicine and to report to them if you have fever, cough or breathing difficulty.

Coping with Diabetes during the COVID-19 pandemic: Results of an online pilot survey

This research article by Sukanya Nachimuthu, R. Vijayalakshmi, M. Sudha, Vijay Viswanathan was published in the journal Diabetes & Metabolic Syndrome: Clinical Research & Reviews 14 (2020) 579-582.

An online based pilot survey was conducted to study how people with Diabetes were coping with their Diabetes during the COVID-19 lockdown. 100 registered patients of the MV Hospital for Diabetes, Royapuram were interviewed via questionnaire consisting of questions about home blood glucose monitoring, regularity in doing their physical activity and dietary compliance and anxiety about the viral infection. On the basis of the patient’s replies, they were advised on dose adjustments, diet and exercise regimes taking into account the pandemic.

Nearly 49 per cent of the study participants were only taking oral anti-diabetic drugs, 43 per cent were using both oral anti-diabetic drugs and insulin and 8 per cent were taking only insulin as treatment for glycaemic control.

The study results showed that 87 per cent of people on insulin were checking their blood sugar levels regularly. 30 per cent of people both oral anti-diabetic drugs and insulin were using SMBG to check their blood sugar levels regularly. Nearly 80 per cent of the study population regularly exercised and monitored their diet. 40 per cent of the people indicated that they were anxious. Yet 73 per cent of the study participants believed that the current situation would eventually improve for the better.

The pilot study highlighted the need for SMBG especially in people taking insulin and on multiple oral anti-diabetic drugs. Educating people with Diabetes and creating awareness about SMBG especially during periods of increased stress is important to keep Diabetes under control and avoid hypoglycaemia.


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