Taking Control of Diabetes: Monitoring Your Blood Glucose

Diabetes is a serious chronic disease affecting more than 16 million Americans annually. Diabetes can lead to short- and long-term complications. In the short term, it can cause hypoglycemia and hyper-glycemia; in the long term, it is associated with many complications, such as kidney, eye, and heart disease and lower-limb amputations. A national study, the Diabetes Control and Complications Trial, has shown that keeping your blood sugar in the normal range will help you prevent the complications associated with diabetes. Maintaining your sugar in the normal range involves following a diabetic diet, taking prescribed medications, visiting your doctor routinely, and, most importantly, monitoring your blood glucose. This is the single most important thing you can do to better manage your diabetes. The values obtained from the blood glucose meters will help your health care team, including your doctor, nurse, and pharmacist, better manage your diabetes. Measuring your blood glucose and recording the results in a diary at regular intervals will help your health care team get a better long-term picture of your glucose values, and they can suggest any appropriate changes to normalize your blood glucose. In addition, blood glucose monitoring will help you prevent and detect hypoglycemia, avoid hyper-glycemia, and adjust your meal plan, exercise regimen, oral medications, and insulin dose.

There are many different types of blood glucose meters currently available. Meters come in varying sizes, price ranges, and storage capabilities, and with different types of lancet devices. There is new technology that allows you to obtain a blood sample from the topside of your forearm or the outside of the upper arm. These areas of the body have fewer nerve endings than the tip of the fingers, thus making it less painful for you to obtain a blood sample. These new meters also have the lancet device built into them and are much easier to handle. Now more than ever, it is very convenient for you to measure your blood glucose. The following questions can help you in selecting a meter that is best suited for you:

• Is the size of the meter right for you? Do you want a smaller meter that will fit in your pocket or purse?
• Can you see the number easily in the display?
• Does the machine have a memory that keeps a history of all your blood glucose readings?
• Are you easily able to push the buttons necessary to obtain a blood glucose reading?
• Is the lance device easy for you to use? For you to select a meter that best suits your needs, it is vital for you to discuss with your pharmacist the different options available.

Once you have selected your blood glucose meter, the next step is to measure your blood glucose. Depending on the type of meter you have, you may have to calibrate the meter with every new box of strips. Usually, you have to enter a number in your meter that corresponds to the number on the bottle of strips. This step is critical in obtaining accurate measurement of blood glucose. In addition, a monthly quality control check is useful. Some meters come with a control glucose solution bottle, which can be helpful in determining if your machine is working properly. You use this control solution on a test strip and match the reading obtained from your meter with the number on the bottle. If the numbers match, then your machine is working properly and you can proceed with checking your blood glucose. The following steps are helpful in obtaining blood glucose measurements from your machine.

• Gather equipment: meter, strips, lancing device, lancets, and blood glucose diary.
• Wash hands in warm water and dry thoroughly.
• Calibrate meter when using a new box of strips.
• Choose and prepare site for obtaining blood sample. If using a fingertip device, it?s best to use the sides of the fingers (balls of the fingertip have more nerves).
• Puncture the skin with a new lancet.
• Obtain a blood sample.
• Apply blood to strip.
• Place strip in machine as directed and read results.
• Record results in blood glucose diary.
• Dispose of sharps appropriately.

If you are having trouble obtaining an adequate blood sample, try the following tips:

• Wash your hand vigorously with warm water to increase circulation.
• Hang your hand down by your side for 30 to 50 seconds so the blood can pool.
• Milk your finger from the bottom to the tip.
• Shake your hand down.
• Use a lancet device with a deeper puncture.

If you are getting incorrect readings, check the following points:

• Strips are overblotted.
• Calibration of meter is done improperly.
• Quality control checks have not been done.
• Meter needs to be cleaned.
• Strips may be outdated or improperly stored (store at room temperature).
• Check the batteries in the meter.
• Avoid storing meter in extreme temperatures (eg, outside or in a car).
• Check expiration date on strips and control solution.
• Do not use test strips that are damaged, wet, bent, cut, or altered in any way.

The best times to check your blood glucose are before breakfast, lunch, dinner, or a snack. Sometimes it can be helpful to check your blood glucose 1 to 2 hours after meals to see the effect of food on your glucose levels. It is best to ask your health care team when it is best for you to check your blood glucose. There are other times when your health care team may recommend that you check your blood glucose more often than usual: increased stress, illness, pregnancy, when changes are made in your medications or meal plan, increased activity, or when you are started on new medications. The ranges for normal blood glucose and hemoglobin values are given in Table 1.

Keeping a logbook of your blood glucose readings is essential in better management of your diabetes. Although most meters come equipped with some type of a memory function to record your

glucose readings, there is other important information that is not stored in the meter. For example, in your log book you can enter the time you ate a meal, what you ate, physical activity, time you took your insulin or oral medications, and anything special or different that may have affected your blood glucose level. The logbook allows your health care team to quickly glance at all your blood glucose readings and help better plan your activities to keep your blood glucose in the normal range.

It is vital for you to play an active role in managing your diabetes. Following a diet plan and taking your blood glucose readings are critical steps you must take in controlling your diabetes. Your participation is essential to your health care team in helping you manage your diabetes. Your health care team can help by prescribing appropriate medications, selecting a diet plan, choosing a blood glucose meter, and providing other follow-up care. However, without the blood glucose readings, they cannot identify trends in your glucose levels and any factors that may increase or decrease your blood glucose. Your active involvement in obtaining the blood glucose readings is a key element in better controlling your diabetes.