A Comprehensive Guide To Self-Monitoring Your Blood Glucose
Blood glucose and diabetes go hand in hand. High blood glucose levels (hyperglycemia) exponentially increase the risk for diabetic damage to the heart, liver, kidneys, and eyes, whereas severely low glucose levels (hypoglycemia) can leave you feeling confused and unable to function normally. This is why blood glucose monitoring and management is so important. However, bi-annual or quarter-yearly A1C tests only give collective glucose readings of the past months. To really understand your diabetes and manage it fully, daily SMBG, or self-monitoring blood glucose is required.
What is the Importance of Self-Monitoring of Blood Glucose?
Daily blood glucose readings provide a wealth of information related to your condition, and can help you and your doctor make progressive decisions about how to best manage your condition and help you live an active, complication-free lifestyle. Here’s why SMBG is so important for anyone with type 1 and type 2 diabetes:
- It helps gauge the effectiveness of, and your body’s response to, a new diet plan, exercise routine, medication and insulin dosage alterations, and make any necessary adjustments.
- Helps in achieving and maintaining target A1C and blood sugar levels.
- Helps prematurely detect, treat, and/or prevent hypoglycemia, hyperglycemia, Diabetic Ketoacidosis (acid/ketone buildup), and Hyperosmolar Hyperglycemic State (urination problems and dehydration due to hyperglycemia).
- Prevention or deceleration of numerous diabetic complications.
- Induces feelings of control, safety, and confidence.
- Helps reduce the number of blood sugar fluctuations throughout the day via careful monitoring and adjustment.
However, simply observing the changes in your blood sugar levels isn’t enough. All of this data has to be recorded either digitally or manually, and evaluated both by you and your doctor to be truly effective in optimal diabetes management. For this purpose, establishing a regular check-and-record routine is imperative.
What are Standard Blood Glucose Targets?
Target ranges vary individually depending upon certain factors like age, time from initial diagnosis, presence of any cardiovascular disease and other underlying conditions, and hypoglycemic tendencies. However, the following A1C and glycemic goals have been suggested by the American Diabetes Association (ADA) for most people with diabetes:
- Daily Checks
- A1C-Less than 7%
- eAG (alternate unit of A1C)-Less than 154 mg/dL
- Preprandial glucose (before meals)-80-130 mg/dL
- Postprandial Glucose (1-2 hours after meals)-Less than 180 mg/dL
- Before Sleeping-100-150 mg/dL
Blood sugar may have to be monitored more frequently, with emphasis on certain points for the following situations:
For Type 1 or Insulin-Treated Type 2 Diabetes
- 6-8 times a day
- Before and after meals
- When hypoglycemia is suspected
- After treating low blood glucose on attaining normal sugar levels (normoglycemia)
- After medication adjustments
- Before driving, exercising, and sleeping
- During pregnancy or illness
For Single Daily Basal Insulin Doses
Fasting blood glucose to help determine the initial, or basal, insulin dose.
For Type 2 Diabetes, Low Hypoglycemia Risk, and Non-intensive Regimens
Glucose self-monitoring is generally less critical. Once daily checks are sufficient, although A1C readings are taken as the primary scale for making treatment adjustments.
Who Should Check Blood Glucose?
While glucose self-monitoring is beneficial for everyone with type 1 or type 2 diabetes, the following individuals require monitoring who:
- have had a recent diabetes diagnosis
- have type 1 diabetes and use and insulin pump (like the Insulato Insulin Pump)
- take insulin
- are starting a new treatment
- are pregnant or planning to
- have difficulty controlling blood glucose levels
- are at risk of hypoglycemia
- experience hypoglycemic episodes without any symptoms
- have ketones due to severe hyperglycemia
- have a medical condition that may affect blood glucose levels
How to Self-Test Your Blood Glucose
Regular glucose self-monitoring is usually done manually via lancets (needles), test strips and glucose meters. Here is how you can monitor your blood glucose using a glucose meter:
- Wash your hands thoroughly and dry them well.
- Insert a test strip into the meter.
- Prick the side of your fingertip with the lancing device to draw blood (no more than one drop). Gently squeeze the end of your finger, if needed.
- Gently press and hold the test strip’s edge to your finger until the glucose reading is displayed in the meter screen. (normal waiting time is a few seconds, though it varies by meter).
- Note the results in a logbook.
- If you use the GluSage Blood Glucose Meter, plug it into the headphone jack of your phone before pressing onto the test strip to simultaneously store your readings into your phone as well as the specialized cloud-synced app.
- Examine your recordings for the past few days or weeks, and consult with your doctor on treatment plan adjustments in case of no improvement.
Note: Always consult your users’ manual for specific instructions as all meters are slightly different.
How should I reduce the pain I feel when testing blood glucose levels?
- Use a new lancet for each test as used lancets are blunter and can cause pain and injury.
- Choose a lancet device with the smallest gauge, i.e. larger number.
- Alternate between fingers and poke the sides instead of the end or middle.
- Squeeze from palm to fingertip when trying to push out blood.
- Consider alternate-site testing, like the arm, although results may not be as accurate in case of rapid blood sugar fluctuations.
How Should I Avoid False Blood Glucose Readings?
- Ensure the test strips have not expired, are in their original container, and that the container was not left open after taking out a strip.
- Ensure that there is no dried blood on the test strips’ opening.
- Keep test strips away from moisture, dirt, dust, and other substances, and store between 4-30o
- Keep the glucose meter away from direct sunlight, moisture, or temperatures under 5oC or over 30o
- Avoid dropping the glucose meter.
What is Continuous Glucose Monitoring (CGM)?
CGM monitors are alternate glucose monitoring devices commonly used by people with type 1 and type 2 diabetes who take multiple daily insulin injections and/or use insulin pumps, or those with frequent hypoglycemic episodes who have difficulty recognizing the symptoms.
They generally consist of sticky patches containing glucose sensors that are attached to the skin. These patches wirelessly transmit glucose readings to a small recording device nearby-usually attached under clothes, in handbags, or on side-tables.
A CGM regularly updates and displays glucose readings which can be downloaded and viewed on any digital device, hence minimizing the need for constant checking and painful pricking. It can also be set to trigger an alarm if blood glucose levels get too high or low, making it highly effective for emergency care and treatment, especially in young children and older individuals.
However, the CGM patch/sensor has to be replaced over a different body part every week, and may require occasional fingersticks due to less accurate readings in case of glucose fluctuations.
Although SMBG is primarily an individual process, do not hesitate to discuss the proper procedures with your care team along with your personal target blood glucose ranges, and always share your collective findings to ensure optimal management.