A key part of managing diabetes is maintaining appropriate blood glucose levels. Diabetes diagnosis is considered when there is a:13,14

·       fasting plasma glucose concentration of ‰¥7.0mmol/l (126mg/dl); or

·       venous plasma glucose level of ‰¥11.1mmol/l (200mg/dl) two hours after ingestion of a 75g oral glucose load hour; or

·       random plasma glucose concentration of ‰¥11.1mmol/l (200mg/dl).

NICE guideline 28, 'Type 2 diabetes in adults: management', sets out a target HbA1c level of 6.5 per cent (48 mmol/mol) for adults managing their diabetes by diet and exercise, or if using a single drug not associated with hypoglycaemia. For adults on a drug associated with hypoglycaemia, the recommended HbA1c level is 7.0 per cent (53 mmol/mol).12

Adults should have HbA1c levels measured at 3-6-monthly intervals until the HbA1c is stable on unchanging therapy, and then every six months thereafter.

Self-monitoring is not recommended routinely unless:12

·       the person is on insulin; or

·       there is evidence of hypoglycaemic episodes; or

·       the person is on oral medication that may increase their risk of hypoglycaemia while driving or operating machinery; or

·       the person is pregnant or is planning to become pregnant.

Short term self-testing may be appropriate if the patient is starting corticosteroids or hypoglycaemia is suspected. Any adult who is self-monitoring should have a structured assessment of their blood testing skills at least annually.

Frequency of self-testing is normally discussed and agreed with patients using insulin. In type 2 diabetes, once-daily insulin dosing should be matched with at least once-daily blood testing.15 The DVLA sets out recommendations on frequency of self-testing for drivers of cars and motorcycles, as well as requirements for those driving buses or lorries.16