Glycemic control is the fundamental goal for managing patients with diabetes. Frequent monitoring of blood glucose (three times per day) is optimal for most patients with type 1 diabetes, type 2 diabetics who are on insulin, and pregnant women taking insulin. The optimal frequency of glucose monitoring for other patients with type 2 diabetes is uncertain and should be determined on a case-by-case basis. Type 2 diabetics who are well-controlled on oral agents, and are not taking insulin, generally have no need for a personal glucose monitor. In the correctional setting, the methods and frequency of glucose monitoring must be determined in light of the institution’s security concerns, as well as the relevant patient factors. The following strategies permit adequate monitoring of blood or plasma glucose in inmates with diabetes. Self-monitoring of blood glucose is the preferred method for assessing glycemic control for most diabetic inmates who require insulin. The following criteria should be used to determine if a diabetic inmate should be issued a glucometer:
• The inmate requires insulin on a chronic basis;
• The inmate has arrived at his designated facility;
• The inmate is highly motivated to monitor his or her blood glucose values; and
• The inmate has no cognitive or sensory impairments that would prevent accurate and safe self-monitoring.
Glucometers should be provided to inmates in accordance with the periodic guidance from the Medical Director that addresses security, logistical, and infection control concerns. Outbreaks of hepatitis B have been reported related to sharing of finger stick devices and glucose monitors. Finger stick devices must be issued for individual use only. Glucometers generally should be issued for individual use, as well. However, if a glucometer must be used by more than one patient, it should be cleaned and disinfected after each use.