How Sweet It Is: Monitoring Blood Sugar at Home

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How Sweet It Is: Monitoring Blood Sugar at Home

Published on: May 11, 2004

By Haran

If you've got diabetes and you're leaving your home for the day, you

may check your bag for more than your wallet, keys and cell phone.

Chances are you also want to bring your glucose meter. Many people

with diabetes monitor their own blood sugar (glucose) levels with

handy meters that test blood sugar levels using a tiny drop of blood.

People with diabetes who do not adequately control high blood sugar

levels run the risk of complications such as heart disease, nerve

damage and blindness. And blood sugar levels that drop too low due to

treatment with insulin can also lead to medical problems.

There are more than 25 types of glucose meters on the market that

have been approved by the Food and Drug Administration. Input from

your medical team, particularly your diabetes educator, will help you

select the right meter for you. Below, Carole Mensing, a clinical

diabetes nurse specialist in the Diabetes Education Program at the

University of Connecticut in Farmington and the president of health

care and education for the American Diabetes Association, discusses

how glucose meters vary and how they can help people control their

diabetes.

How do glucose meters measure blood sugar?

Generally speaking, you prick your cleaned finger with the lancet

provided and place a drop of blood on a test strip that is then

inserted into the meter. Some of the newer meters allow for

alternative sites, such as the palm of the hand or the forearm. This

is helpful for people whose fingertips get irritated, particularly

folks who use their hands a lot, such as hairdressers, auto

mechanics, typists or guitar players. However, the forearm is not as

accurate if the blood glucose is too low, so we're cautious about

that.

Test strips can come individually wrapped or in a disk or little

cartridge, so you just punch a button on the machine and it

automatically gets the strip ready for you. Once you place the blood

on the top of the strip, the meter reads the test strip in anywhere

from five seconds to 40 seconds and displays the glucose level.

Most of the meters now store the numbers so that patients get an

individual number, a summary of numbers over a 14- or 30-day period,

and then an average. Many of the meters store up to 1,000 test

results. And many of them can have the information downloaded into

the computer so that, with the appropriate software, the data can be

displayed in different ways and used by patient and their medical

team.

Are there other kinds of devices that people can use to measure their

own blood sugar?

There are some devices that can be worn like a wristwatch that take a

blood sugar reading from fluid drawn from under the skin with

electrodes, rather than from blood. These devices run on disks that

adhere to the skin and should be changed periodically. These devices

can read levels as frequently as every 10 minutes and be worn for as

long as 13 hours, and there is an alarm that goes off when blood

sugar levels rise too high or fall too low. They are very helpful for

pregnant mothers who want to catch low blood glucose that occurs at

night. Although people will think of these devices as a replacement,

they are more of a useful supplement to standard glucose monitoring

because they can take so many readings.

How does self–glucose monitoring help someone control their diabetes?

It's like keeping a diary. When you work with a professional team, we

look for patterns. Patients bring the history of all the blood sugar

levels they've done to the appointment.

We try to determine if there are any confounding factors that might

be affecting your blood sugar. For example, if someone's blood sugar

is always high at noontime or in the evening, we can try to figure

out if we should make any alterations in either their food or

medicine that might help them keep their blood glucose in the target

range at that time of day. Sometimes people forget to take their

medicines, or maybe their medicine has gone bad or is outdated. The

meter can serve as a good alert system to these kinds of problems.

Research tells us that if people consistently stay in the target

range for their blood sugar, they can lessen the complications of

diabetes. If you don't self-monitor, there is less information to

work with. The more information someone can give us, the better we're

able to help them problem-solve.

How often should people monitor their glucose levels?

It depends on the type of diabetes they have and which treatment plan

they are using. For people with type 2 diabetes for instance, who are

on meal planning alone, we might recommend at least twice daily, one

test in the morning before they eat and another one perhaps two hours

after a meal in the afternoon. For people with type 2 diabetes who

are on oral medication or insulin, we would recommend a blood sugar

test in the morning before they eat, and then one two hours after

their big meal of the day. If they can do some pre- and post-meal

testing on occasion, that's useful to make sure that the medicine is

working and to find out if we need to make adjustments.

For someone with type 1 diabetes, we'd recommend they use their

glucose meter before meals, to assist with insulin adjustment based

on their target blood sugar levels and the amount of carbohydrates

eaten, and two hours after meals, to see if the dose worked. Women

with gestational diabetes are advised to test themselves before

breakfast and one to two hours after meals if they are using diet

alone to control their diabetes. They should follow the

recommendations for people with type 1 diabetes if they are using

insulin.

What should guide a person when selecting the best monitor for them?

Convenience and size are big issues. Some people like a real small

meter they can slip in their pocketbook or their pocket and take with

them. Individuals who have a problem with dexterity might prefer a

larger meter or larger strips that that they can handle more easily.

Some people prefer a larger meter where they can clearly see the

numbers. Someone with vision problems might also prefer to have a

meter that has a good contrast between light and dark in the display.

There are also audio-enabled meters for visually impaired people.

Another consideration is cost. Some meters and strips are more

expensive than others. The more expensive meters might have a faster

testing speed, or more gadgetry, such as meters that have the test

strips that load automatically.

What's considered a normal range for blood sugar levels?

We usually recommend that patients keep their blood sugars between 80

and 160 mg/dL. If it's out of that range, we recommend they test

again in about 15, 20 minutes. It's important that people with

diabetes understand that blood sugar fluctuates. If the blood sugar

level is high or low and comes into normal range at the next testing,

it's not as concerning as if it stays elevated for two or three tests

in a row.

But testing can also make sure their blood sugars aren't getting too

low, so that they become hypoglycemic. This is particularly a concern

for people who are on insulin and oral medications that stimulate

insulin production. They may be at risk for low blood sugar if they

haven't eaten or if they've exercised intensely. With hypoglycemia,

you often get dizzy, sweaty and shaky and lose of your control of

your body functions. We really encourage people who are taking

medication to test blood sugars before they drive, for example, and

if the blood sugars are low, to eat something.

What are the most common mistakes people make with self-monitoring?

The biggest mistake is they don't test often enough. Other mistakes

are not getting a good drop of blood or contaminating the sample by

not cleaning their hands.

Is there a way to test the meter to make sure it's accurate?

Yes, each meter is supplied with a quality control system that we

recommend patients use periodically. Usually it comes with a solution

that has a known glucose value and you place that on a strip and

compare the number on the meter to the range assigned for that fluid.

If it's within that range, then the meter is accurate.

Are the meters covered by insurance?

The average meter runs about $50. They're often covered by insurance,

but not always. The number of strips are covered by insurance, too,

but are the number of strips may be limited depending on the

insurance plan.

Why is it important that people continue to be monitored by their

medical team?

I think people sometimes feel like getting a meter takes care of

their diabetes for them. And that really is not the message we want

to give. The meter is a tool, and people still need to see their

medical team. We recommend that people with diabetes see their

medical team every three to four months.

During those visits, we will draw their blood to test the blood sugar

in a lab. We also do a physical exam to make sure there aren't any

other problems that can occur as a result of diabetes. For example,

we'll do a quick eye exam. We'll also make sure they don't have

neuropathy, or nerve damage, in their legs. We might do urine testing

to make sure there's no kidney involvement.

What can people who are unable to self-monitor do?

There are different groups of people who either can't afford a

glucose monitor or just physically aren't able to do it themselves.

We try and encourage family members and/or support systems like the

Visiting Nurses Association to help the patients with blood sugar

monitoring. Or we encourage these individuals to have periodic blood

sugars drawn as often as they can so that we can get the information

that way