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WW is a 55 year old, obese male (BMI 35) with newly diagnosed type 2 diabetes. His most recent fasting blood glucose is 9.6 mmol/L and A1C is 8%. He also suffers from hypertension and osteoarthritis in his knees. His current medications are: ramipril 20 mg po daily and acetaminophen 500 mg po qid. After starting on the anti-hyperglycemic agent, WW would like advice regarding self-monitoring of his blood glucose. Which of the following statements is most appropriate for WW?

  1. Blood glucose should be tested upon waking and before each meal.

  2. Self-monitoring of blood glucose is not warranted at this time.

  3. WW should avoid testing at alternate sites (e.g., forearm) since accuracy is reduced in obese patients.

  4. Self-monitoring will help WW to adjust the dosing of oral therapy in relation to meal size.

The correct answer is: Self-monitoring of blood glucose is not warranted at this time.

Self-monitoring of blood glucose is not warranted at this time for WW. The reason for this is because his current medication regimen and newly diagnosed type 2 diabetes do not necessitate daily monitoring. Monitoring blood glucose is typically recommended for individuals with diabetes who are on insulin therapy or who are at risk for experiencing hypoglycemic episodes. Since WW is not on insulin and does not have a history of hypoglycemia, self-monitoring is not necessary for him at this time. Option A is incorrect because testing blood glucose upon waking and before each meal is typically recommended for individuals with type 2 diabetes who are on insulin therapy. In WW's case, he is on oral medications and does not require this level of monitoring. Option C is incorrect because accuracy of blood glucose testing is not affected by obesity. However, alternate sites may not provide consistent results and it is recommended to test