Glucose Monitoring: Timing Makes Every Reading Count

A glucose reading is only as useful as the context around it. For patients who check with a fingerstick, testing at consistent, purposeful times can turn scattered numbers into patterns that guide treatment decisions, and pharmacists are well placed to help patients build that routine.

"The reason it's important to have some structure around it is because everything around you can alter that reading," Nicole Albanese, PharmD, CDCES, BCACP, a clinical associate professor at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences, said in an interview with Pharmacy Times.

The American Diabetes Association (ADA) 2026 Standards of Care make a similar point: "performing BGM alone does not lower blood glucose levels," and optimal use of blood glucose monitoring (BGM) requires proper review and interpretation of the data.¹

Why Structure Matters for Point-in-Time Readings

Albanese noted that the need for a structured plan applies mainly to fingerstick testing. "A CGM is going to give it to you all the time," she said, referring to continuous glucose monitoring. For those patients, the ADA recommends reviewing standardized reports, such as the standardized CGM report and weekly summary.¹

A single fingerstick, by contrast, captures 1 moment, and Albanese said that moment can shift with meals, physical activity, and hormones patients cannot see or control. She described patients who experienced low glucose after strenuous yard work, as well as patients who slept late and appeared to have morning hyperglycemia because they had fasted longer than intended.

Building the Testing Schedule

The ADA notes that for patients taking insulin, checks may include fasting, before meals and snacks, after meals, and at bedtime, and that for people on basal insulin, assessing fasting glucose to inform dose adjustments is associated with lower hemoglobin A_1C. That makes structured fasting checks especially relevant as more patients start basal insulin, including the once-weekly options approved this year.^1,2

For patients on noninsulin therapies, the ADA says evidence is insufficient on when to prescribe BGM and how often, with benefit seen mainly in structured clinical programs, and that the need for and frequency of monitoring should be reevaluated at each routine visit.¹

Albanese typically starts patients with a fasting morning reading plus readings 2 hours after breakfast, lunch, and dinner or bedtime. She said glucose tends to peak about an hour after eating and settle by the 2-hour mark. "We like people to test 2 hours after they've eaten; that gives us more data," she said. Patients do not need every slot every day. "You can do just one of those, and that can paint a really good picture."

Context Makes the Numbers Useful

Albanese said the readings themselves are only half the record. When a health care provider asks a patient to log glucose for 2 weeks before a visit, "That's great, but if that's all they write down, it's not going to be very useful." Instead, she encourages patients to note meals, stress, missed meals, travel, and other events alongside each value.

Her own counseling follows the same logic: "What time was that? What else did you do? When was the last time you ate? What did you eat?"

That context lets clinicians sort readings into time-of-day groups and look for trends rather than react to 1 value. "If you have a couple of outliers, that's okay. We don't care that much about it. We're looking for the overall pattern," she explained.

Without it, she warned, a single high reading in an otherwise stable log could prompt an unnecessary medication increase. Pharmacists who teach patients what to record and why help them arrive at appointments ready to explain their numbers. As Albanese put it, "education is power."

REFERENCES

1. American Diabetes Association Professional Practice Committee for Diabetes. 7. Diabetes technology: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S150-S165. doi:10.2337/dc26-S007

2. FDA approves Onswik, a once-weekly basal insulin, for adults with type 2 diabetes. Healio. September 24, 2026. Accessed November 12, 2026. https://www.healio.com/news/endocrinology/20260924/fda-approves-onswik-a-onceweekly-basal-insulin-for-adults-with-type-2-diabetes