- See the new glucose sensor
- buying a testing meter
- using a glucose testing meter
- use the results
- test in type 2, diet controlled..good control
- test in type 2, diet controlled..poor control
- testing in type 2, tablets
- using insulin
- a blood sugar graph for you to use
- Graph for recording glucose levels...diary, & diary instructions
- continuous monitoring
- meters for people with poor sight
Testing your blood sugar
See the new glucose sensor
At present in October 17 for £30 a week, you can test your (interstitial) glucose levels, and this could really help insulin users. It does not measure the blood glucose, but it measures the glucose in the tissue fluid. Tissue fluid interstitial glucose takes 15 minutes to catch up with the blood glucose level, but this will not be a problem most of the time. See. If you live near Good Hope and would like to try a sensor free for 2 weeks only, please contact my (DK) secretary at Good Hope. Here is the evidence 27214060 27641781
But NICE recommends they are funded even at present see
"CGM may be considered appropriate under the following situations:
- If having more than one severe hypo a year that’s brought on by no obviously preventable cause.
- A complete loss of hypo awareness.
- Frequent episodes of problematic hypos occurring without symptoms.
- If an extreme fear of hypoglycemia is causing problems or distress.
- If unable to achieve an HbA1c of under 75 mmol/mol (9%) despite testing blood sugar levels at least 10 a day.
CGM use can be applied if the following factors also apply: 
- The intended user of the CGM is willing both to commit to using the CGM at least 70 per cent of the time and keep it regularly calibrated.
- The user is on multiple daily injections or insulin pump therapy.
- The health team providing the CGM has the expertise to advise on effective use of the CGM."
There are many new glucose testing meters. Your diabetes nurse will need to show you how to use these. For people with no fingers or very tender fingers there is a 'vaculance' which can be used on other parts of your body, including your tummy. Please ask your specialist nurse to advise you, especially if you have difficulties as poor sight or no fingers.See lancets.
Prick the side of the finger
To test your sugar/glucose level, follow the instructions with your meter:
- Wash your hands with warm soapy water, dry them, otherwise you may measure the sugar content of your last meal!
- warm and shake your hands, particularly if your finger does not bleed much when pricked. This increases the blood flow so you bleed more when you prick, making it easier to obtain blood to test
- Prepare the blood sugar meter (glucose meter). Follow the instructions included with your meter.
- Place a strip in the meter (put the lid back on the strip bottle immediately)
- this excellent page tells you how to test in detail, with an extract below
- Insert a clean lancet in the lancet device.
- Adjust the lancet prick depth... how deeply the lancet goes into the skin.
- Prick the side of your fingertip with the lancet.
- Do not stick the tip of your finger; the prick will be more painful and you may not get enough blood to do the test accurately.
- (Some new blood sugar meters use lancet devices that can obtain a blood sample from sites other than the fingers, such as the palm of the hand or the forearm).
- Put a drop of blood on the correct spot of the test strip. Some meters also allow you to put the test strip in the machine before placing the drop of blood on it.
- Press on the your finger prick site
- Follow the directions with your blood sugar meter to get the results.
- Write down the results and the time that you tested your blood..also record food/exercise/how you feel.
- adjust the lancet depth for next time..if there was more blood than you needed, use less depth next time. If there was not enough, use a deeper depth next time.
|Units mmols/l||type 1 children & young people||type 1 adults||>type 2 adults|
|aim for a sugar before meals||4-8||4-7||4-7|
|aim for 2 hours after meals||less than 10||less than 9||less than 9|
- You need to test more often if you are ill (you need more insulin if you have an infection for instance).
- vary your testing times.
- If your sugars suggest you are well controlled (e.g. 5-6 mmols/l before meals less than 9 mmols/l two hours after meals) , but your next HbA1c 1 month later is above 7% / 53 mmols/l , then the results do not agree. There may be some other problem. Your testing technique may be incorrect, or you may not be testing at the appropriate times.
- Any glucose reading below 3.6 is a hypo. Readings 3.6-4.0 are good readings, but they only have to drop a little further to cause a hyps, so readings >4.0 are preferred.
If you have type 2 diet controlled diabetes you do not need to test often. This article ( & BMJ 2012) suggests there is no point testing regularly if your diabetes is well controlled. I would suggest occasional testing, perhaps once a week, at different times as below, is probably best, just to check your diabetes is controlled. But if your results are higher than ideal, you do need to take action. This article points out that patients do not take action if the results are high (summary opposite)
- doctors may use the HbA1c and ignore patients worries (such as glucose spikes)
- patients find results difficult to interpret and act on
- few patients use the results to change their diet/lifestyle
- education needs to be focused on goals, clear, individual, and on-going print out
- doctors/nurses may not be sufficiently interested in results.
- see the conversion chart
See and print out If your diabetes is not perfectly controlled and you are trying to improve your control, you should test:
- Occasionally test 2 hours after meals: if your sugar is more than 9 mmols/l
2 hours after after a meal it is too high.
- you may have eaten too much food
- eaten the wrong (or not the ideal) food
- need more medication
- if this sugar level stays above 9 mmols/l 2 hours after meals you need to see your doctor as you probably need tablets for your diabetes.
- Check your fasting sugar
- this is often equivalent to your overall control
- test first thing in the morning occasionally, before you have eaten.
- If your results are persistently high (higher than 7 mmols/l before meals or HbA1c >7% / 53mmol/mol) you need to see your diabetes doctor/nurse and probably need medication (or more exercise).
- A fasting sugar of 6mmol is often equivalent to an HbA1c of 6-7% / 42-53mmol/mol, which is good (HbA1c 6% / 42mmol/l) or reasonable (HbA1c 7% /53mmol/mol) control.
- Check at other times, especially when ill, to check you do not need tablets.
- Use these results next month.
- For instance, if your fasting sugars were 8 mmols/l and your HbA1c 8% / 64mmol/l, then your diabetes is not as well controlled as is recommended, so aim for fasting sugars of 6 next month.
- To do this you will need to eat less sweet or fattening food (see diet), or exercise more, or both. (Alternatively you may need to start tablets.)
- Your practice nurse can test your HbA1c for you every 3-6 months, so you can compare your own testing results to the HbA1c level.
- If you are not trying to improve your diabetic control, then there is little point in frequent testing BMJ 2012.
Good times to test glucose for non-insulin users (different times each day)
- before breakfast = fasting
- 2 hours after breakfast
- 11 am
- before lunch
- 2 hours after lunch
- 5.00/5.30 pm
- before supper
- 2 hours after supper
- before bed
- 3.6-6.5 before meals
- 3.6-6.5 before meals and 4 hours after a meal
- less than 9 2 hours after a meal
What do results mean?
Higher results for 2-3 days means you need more medication/less food/more exercise .
Lower results for 2-3 days means you may need less gliclazide etc (metformin does not cause hypos
- Test as for diet controlled as above. If you get consistently good results (4-6 before meals) and less than 9-10 two hours after a meal) you do not need to test all that often.
- If you are getting results 7 or above before meals 10 and above after meals, you may need more medication (or smaller meals with more vegetables and less meat : see diet).
- The fasting blood sugar (first thing in the morning before breakfast is a good measure of your control, but you do need to test at different times each day).
- However, the HbA1c is usually a more accurate measure of your control. So your doctor and nurse will tend to use your HbA1c result to determine whether or not more medications are needed. For more details, see type 2 diabetes
This link http://www.mendosa.com/logsheet.pdf will take you to an excellent document that you can print out to record your glucose, exercise, food, and insulin on one page. This will make it very difficult to see what is happening your diabetes, and very easy to show your diabetes nurse who can help you improve your control if need be.
Continuous monitoring is becoming popular in the US and can improve control. This generally not funded in the UK, but is helpful for many people
See these talking meters.