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Home testing of the blood glucose (see Chapter 7) is a truly valuable tool that has made an enormous difference in the successful management of T1DM. It's truly amazing that you can know your child's blood glucose in 5 seconds with less than a drop of blood. At first, your child won't like it, but with repetition, blood glucose testing hurts less and less and becomes more and more routine.

Monitoring the blood glucose provides a snapshot of your child's metabolism at a given instant in time. It provides the critical information that allows you to choose the proper dose of insulin to keep the blood glucose in a range of 80 to 140 mg/dl. A patient with an average blood glucose in that range will never suffer from diabetic complications.

How much testing should you do? The more, the merrier, as they say. There's no doubt that a major difference between my patients with T1DM who successfully manage their diabetes and those who have difficulty doing so is that the former test their blood sugar far more than the latter. I recommend testing at the following times:

i Before meals to figure out the bolus of insulin to give for the meal, depending upon the current blood glucose and the amount of carbohydrates about to be eaten (see Chapter 10 for more about insulin dosages)

i An hour after eating to gauge the rise in blood glucose with food and to respond with extra insulin before that meal next time i At bedtime to see if your child is going to sleep with a low blood glucose, in which case a bedtime snack is in order to prevent hypoglycemia i Frequently when your child's sick because illness causes major changes in blood glucose (see Chapter 15 for more about handling sick days)

i Occasionally at other times just to see how a given food or a certain amount of exercise affects your child's blood glucose

The other kind of monitoring that you can do is monitoring of the ketones in the blood. It requires a specific monitor but can give you a very early clue that your child is headed for diabetic ketoacidosis. I describe this test more extensively in Chapter 15. Testing the blood for ketones has resulted in earlier admissions to hospitals when necessary and shorter hospital stays.

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