Take Control: Blood Sugar Monitoring in Diabetes
Philip T. Rodgers, PharmD, BCPS, CDE, CPP, and Sara Bristol Calvert, PharmD
(from Pharmacy Times)
Why Do You Need to Test Your Blood Glucose?
Diabetes is a disease that lets you see easily how well it is being controlledby testing your blood glucose. Many diseases cannot be monitored so directly. You can get valuable insight into your diabetes by testing your glucose at home and recording the values in a logbook (or downloading them to a computer, if one is available).
Your glucose will change with eating, with exercising, and with medications. It may be controlled in the mornings but high in the afternoons, or high in the mornings but well controlled later in the day. By studying these patterns, you and your doctor can adjust your therapy to get control. Recommended goals for glucose from the American Diabetes Association are listed in Table 1.
Also, blood glucose monitoring will help you detect and manage low blood sugar episodes that may need to be treated quickly. Reviewing them can help your doctor adjust your therapy appropriately to prevent serious low blood glucose attacks.
How Do You Perform a Blood Glucose Test?
We will describe here the basic steps to follow for a blood glucose test, but you should see your specific meter manual for details.
- Wash your hands with warm soapy water, rinse them, and dry them completely. Cleaning them with alcohol is not recommended because it can cause dry skin or soreness and may affect the test.
- Prepare the lancing device, turn the meter on, and insert the test strip. Note that some meters turn on when the strip is inserted, so read your meter’s instructions carefully.
- Lance the side of your fingertip, avoiding the pads or ends of fingers to prevent discomfort. Gently squeeze your finger to obtain a drop of blood.
- Apply the blood sample to the test strip. Many strips are designed to draw blood into the strip when placed at the edge. In a few seconds, the result will appear on the meter screen.
- Record the reading in a logbook. The result also may be stored in the meter’s memory, if the meter has this capability.
- Remove and discard the test strip.
Alternative-site testing may be preferredthe blood sample may be obtained from a less painful area, such as the forearm. The manual will say whether your meter can test blood at alternative sites. Readings may be slightly different, compared with fingertip results. Gentle massage or application of heat to the area will increase blood flow and possibly reduce differences in readings. If you suspect, however, that you are having a low blood glucose episode, test from your fingertip to get the most accurate results.
How Often Should You Test Your Blood Glucose?
If you have type 1 (juvenile) diabetes or if you have type 2 (adult) diabetes and take insulin, it is recommended that you test your glucose at least 3 to 4 times a day. You usually would test it before meals and at bedtime, but some people may test it after meals. Studies have shown that frequent testing by patients taking insulin is beneficial to overall health.
| Table 1 | |
|---|---|
| Goals for Blood Glucose | |
| Time of Glucose Test | Goal for Glucose |
| Before a meal | Between 90 and 130 mg/dL |
| After a meal (2 hours preferred) | Less than 180 mg/dL |
If you have type 2 diabetes and take oral medications only, you should test your glucose often enough to get control. Some patients may have to test it 4 times a day, but others only 1 to 2 times a week. In general, most patients on oral medications should test at least once a day, commonly first thing in the morning. It may be beneficial, however, to test at other times to ensure that your glucose is controlled all day long.
Finally, for those with type 2 diabetes who control it with diet and exercise alone, blood glucose monitoring is not generally recommended. Your doctor may want you to occasionally test your glucose, however, to be sure that you remain well controlled. It is not recommended that patients with “prediabetes” test their glucose because there are no known benefits, compared with the costs and inconvenience of the monitoring.
How Do You Choose a Meter?
Some factors to consider are cost, ease of use, meter memory, alternative-site testing, and ability to download to a computer. Test strips are the most expensive item. Free or reduced-cost meters are available with trade-ins or rebates. Insurance companies often pay for testing supplies but may cover only certain brands.
Consider a meter approved for alternative-site testing if pain from fingertip testing is bothersome. Some meters require blood samples smaller than a pinhead and may reduce time and effort. If speed is important, look for a meter that gives readings quickly (in 5 seconds). Simple meters do not require buttons and turn on when the strip is inserted. More complex meters are available with features such as storing strips within the device or elaborate memories. Memory storage ranges from 10 readings to more than 450. Features vary from giving only results, to averages, to graphs and charts.
Finally, many meters can be downloaded to a computer. The software creates logbooks, charts, and graphs of blood glucose readings. Contact your meter manufacturer for computer requirements, or ask your doctor if the meter can be downloaded in his or her office. For a list of specific meters, see Table 2.
Conclusion
Blood glucose monitoring can be a powerful tool to help you understand and take control of your diabetes. You should test your blood sugar frequently if you are taking insulin or possibly if you are taking oral medications. Choosing a meter can be confusing, but the actual procedure of the test is generally the same with most meters. Your doctor or pharmacist can help you identify the meter that meets your needs and budget.
| Table 2 | |
|---|---|
| Blood Glucose Meter Manufacturers and Contact Information | |
| Abbott Labs | www.abbott.com |
| Accu-Chek by Roche | www.accu-chek.com |
| Ascensia by Bayer Diagnostics | www.ascensia.com |
| Becton, Dickinson and Co. | www.bddiabetes.com |
| Cygnus | www.glucowatch.com |
| Home Diagnostics Inc | www.hdidiabetes.com |
| Hypoguard by Medisys Group | www.hypoguard.com |
| LifeScan by Johnson & Johnson | www.lifescan.com |
| Medisense by Abbott Labs | www.medisense.com |
| Medtronic MiniMed | www.minimed.com |
| Metrika Inc. | www.a1cnow.com |
| Polymer Technology Systems | www.ptspanels.com |
| QuestStar Medical | www.queststarmedical.com |
| TheraSense | www.therasense.com |
©Pharmacy Times October 2003