Adjustment of caloric intake based on self-monitoring in noninsulin-dependent diabetes mellitus: development and feasibility.

It has been recommended that patients who perform self-blood glucose monitoring use the information gained from the test to alter their diabetic regimen. Skyler et al. have proposed algorithms for patients to adjust their insulin dosage when blood sugar is elevated. However, the clinical result of increasing insulin dosage may be the promotion of weight gain. We proposed that altering the regimen by decreasing caloric intake is an appropriate first approach for NIDDM patients for whom weight loss would be of considerable benefit. Results of an initial needs assessment showed that patients did not generally regard testing and adjusting therapy as important in taking care of diabetes. A recent study by Fox et al. reported similar results, showing that a large portion of patients using blood glucose self-monitoring do not make changes in their regimen when they know that their blood sugar is elevated. Consequently, we implemented a half-day seminar to instruct patients on making adjustments in their dietary regimen on the basis of results of glucose monitoring. Results suggest that our teaching methods were effective in teaching patients to follow the adjusting algorithm. Although we observed trends toward improved metabolic control and weight loss, further studies are required to document the clinical benefit of adjustment of caloric intake based on self-monitoring in diabetes.