Quantitative Glucose Monitoring
Glucose monitoring in the evaluation of the LEO includes assessment of hypoglycemia and overall control using downloaded glucose meter logs and hemoglobin A1C. Only downloaded data directly from the glucose meter is acceptable; handwritten or typed logs are not acceptable. Data recorded by the meter should be tamper-resistant.
The LEO has documentation of ongoing self-monitoring of blood glucose, i.e., glucose log. Glucose logs include glucose readings downloaded from a glucose meter or from a continuous glucose monitor.
Glucose monitoring must be done with a glucose meter that stores every reading, records date and time of reading, and from which data can be downloaded and printed.
After treatment has stabilized for the time period as described under Criteria for Stable Regimen, the glucose log must be available covering the time periods below:
- LEO with type 1 diabetes: 1 month, as suggested in the table below
- LEO with type 2 diabetes on insulin: 1 month, as suggested in the table below
- LEO with type 2 diabetes not on insulin but taking sulfonylurea: 1 month, as suggested in the table below
- LEO with type 2 diabetes not on insulin or sulfonylurea: as recommended by treating physician
The frequency of glucose monitoring must follow a schedule acceptable to the police physician in consultation with the treating physician. Testing schedules are individual. What follows are common maintenance patterns, but individual patterns may differ. The table below provides suggested glucose testing schedules.
Table 1. Glucose Monitoring Schedule
|Daily Therapeutic Regimen||Glucose Testing Schedule|
|Diet alone||Every 1 to 2 weeks for maintenance evaluation by the treating physician|
|Metformin, thiazolidinediones, or alpha glucosidase, or DPP-4 inhibitors, SGLT-2 inhibitors, GLP-1 agonists — alone or in combination||Every 1 to 2 weeks for maintenance evaluation by the treating physician|
|Sulfonylureas, meglitinides, nateglinide – alone or in combination with the above group||Twice a day
|With any suspected hypoglycemic episodes|
|After treating low blood glucose, repetitively test at a minimum of every 15 minutes until >90mg/dl.|
|Insulin – 1 dose of long-acting insulin alone or in combination with other medications (other than sulfonylureas, meglitinides, or nateglinide)||Twice a day
|After treating low blood glucose, repetitively test at a minimum of every 15 minutes until until >90mg/dl|
|With any suspected hypoglycemic episodes or after an increase in overnight insulin, glucose should be checked once a week between 2am and 3am|
|Insulin – 2 or more doses daily, insulin pump, or in combination with any non-insulin anti-diabetic agent||Multiple times a day (3-4 times a day) for example:
A blood glucose less than 70 mg/dl needs to be rechecked and treated immediately, and then repeated, at a minimum, every 15 minutes until a glucose value of 90 mg/dl or greater can be demonstrated in the glucose log.
The LEO with diabetes should have his/her hemoglobin A1C measured every 2-3 months.2(p 21-23) The A1C value should not be the sole determinant of ability of the LEO to carry out his or her duties.5 However, if the hemoglobin A1C is 8% or greater, this may signal a problem with the LEO’s diabetes management; this warrants further assessment by the LEO’s treating physician2(p S25-26) who should ensure that:
- The treatment has been reviewed and, if indicated, adjusted, and
- Criteria from the above sections on Overview of Medical Evaluation and Quantitative Glucose Monitoring are met, and
- Information as described in Appendix B (Physician Evaluation Form) has been reviewed by the police physician and by the treating physician (especially the glucose log).