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Home Blood Glucose Monitoring

Individuals with diabetes have a very important role in their own medical care, and home blood glucose monitoring is an opportunity for them to take control of their own health. Home blood glucose monitoring (HBGM) is the ongoing measurement of blood sugar (glucose). It is a method of self-testing blood sugar levels for the management of diabetes.

According to the American Diabetes Association there are four major reasons for using HBGM:
1. To control glucose at a specific, healthy level;
2. To detect and prevent hypoglycemia and severe hyperglycemia;
3. To adjust care in response to changes in lifestyle for individuals requiring medication;
4. To determine the need for starting insulin therapy in gestational diabetes (diabetes that happens in pregnancy).

Diabetes is a chronic disease but it can usually be controlled with lifestyle changes and medications. The main goal in the treatment of diabetes is to keep blood glucose levels in the normal to near normal range and HBGM is an important tool in achieving this goal.

Accurate and correct blood logs are critical in making decisions regarding treatment. Patients should be truthful in recording and reporting their blood glucose results to their physician. Some patients make up better results to please their physicians. Some pregnant women do it because they do not want to go on insulin. Others do it because they do not know how to work the monitor and are too embarrassed to ask for help.

There are patients also that give incorrect results because they are afraid the medical team would judge them for not being able to control their diabetes better. People with diabetes must not identify themselves with their numbers and must not feel bad when the blood glucose is not in control. The blood sugar numbers should not be referred to as “good” or “bad “. It is better to refer to the numbers as “on target” or “out of target”. Physicians and patients should treat the data non-judgmentally. The diabetes educator should teach the patient what to do with the numbers and when to contact their heath care providers.

The optimal time and frequency of HBGM depends on the age of the person, type of diabetes, type and timing of medication, co-morbities, treatment goals, and history of glycemic control.

HBGM is especially important for diabetic patients who are:

  • Taking insulin and other diabetic medications;
  • Pregnant;
  • Having difficulty controlling blood sugar;
  • Having ketones in urine from high blood sugar;
  • Having hypoglycemia or hyperglycemia without the normal warning signs;
  • Having an illness and other stressful conditions.

Blood glucose testing results can be affected by activity levels, food eaten, and medications. It is important to consider these factors when one interprets the results. Both physician and patient should examine and review patterns in the glucose test results and see if the diabetes management plan is working or if changes need to be made.

Record Keeping
Recording of the results is very vital in HBGM. Although today most of the meters can store the number results, it is best that the patient have a written blood glucose record. The blood glucose record should include the time and the date, blood glucose results, and dose of medication used. Additional notes about food intake, exercise and difficulties with illness are helpful but are not generally required everyday.

The written record offers the benefit of organizing blood sugar readings during the day. The patient and the health care team are able to observe glycemic patterns thus treatment plan can be instituted. The diabetes educator/health team should be able to teach the patient the proper way to record the blood sugar results and how to use results to control blood glucose levels. Patient’s ability to use HBGM data should be checked and evaluated at regular intervals. Health care providers must look at the records and interact with the patient regarding the interpretation of the number results.

Monitoring Procedure
• Clean hands with soap and water or an alcohol swab. Completely dry the skin before pricking.
• Prick the lateral side of finger with the lancet or the puncture device. Apply the hanging drop to cover the entire test strip.
• Insert the test strip at the appropriate time into the monitor/meter. Results are displayed on the meter after several seconds.
• Record the blood glucose values properly. Write also pertinent data in connection with the results acquired.
• Dispose of the used lancet in a puncture resistant sharps container (never in household garbage).
• Clean the meter as needed.

Glucose Meter Altenative names:
blood glucose meter,
blood glucose monitor,
blood glucose (sugar) testing device

Considerations when choosing a meter:
• Cost — Promo offers like rebates, trade-ins and discount sales are available, making them affordable for everybody. Check the cost of supplies that go along with the monitor including test strips, lancing device, and lancets
• Ease of usage — Most are pretty small and easy to use. Some require a tiny sample of blood. Meters nowadays have a memory and retain a record of blood glucose results. Meters may vary in how quickly they give the results. User’s manuals provide necessary information on the usage of the meter.

• Accuracy — Glucose meters take a reading from the test strip with blood. The code programmed into the meter must match the current batch of test strips. Test strips must be kept in the vial or package they came in. Exposure to light and moisture may ruin them, thus affecting the accuracy of the results when used. Control solutions are available to use with test strips to check meter accuracy. Meters should be checked for accuracy every three months or when in doubt. Other factors that may affect the accuracy of the meters are size and quality of blood sample, certain drugs in the blood, hematocrit level, dirt on the meter, humidity, and aging of the test strips. Always check the package instruction of the meter to find out what substances and other conditions that might affect the testing accuracy of the meter.
• Sophistication — All meters now have a clock and a memory of past test results. New meters have the capacity to read blood samples taken from alternate sites (i.e., sites other than the fingertips such as the forearm or thigh). Some meters allow entry of data on carbohydrate grams eaten, exercise, or insulin doses received. Some meters have the ability to download results to a computer for printouts. There are also meters for persons who are visually impaired. Advanced technology in the development of new meters are being done for future use.

Measurement range
Most meters are capable of reading glucose levels from as low as 0 to as high as 600 mg/dL (the measurement range differs among meters). Very high or low levels should be interpreted very carefully. Accepted blood glucose range for non-pregnant individuals with diabetes bef e meals is between 70 to 130 mg/dL while after meals, should be less than 180 mg/dL. However, this measurement range is not appropriate for everyone.

The target glucose range is a personalized number given by the physician-in-charge and is usually based according to the patient’s needs and conditions. Patients should aim to keep their glucose levels within their personalized range.

The glucose numbers are displayed in the small window of the meter. The measurement unit used (mg/dL or mmol/L ) varies by country. The unit of measurement can be programmed in many meters. To avoid misleading data information, the physician and the patient should agree on the specific type of unit to be used for uniformity.

Whole blood glucose vs. plasma glucose
Glucose levels in plasma (one of the components of blood) are generally 10-15 percent higher than glucose measurements in whole blood. Glucose meters measure the glucose in whole blood while lab tests measure the glucose in plasma. It is advised that plasma blood glucose levels obtained in the laboratories be done on a regular basis to ensure the accuracy of HBGM.

The health care providers/ diabetes educators have a very important role in the home blood glucose monitoring of diabetics. Their task is to provide the necessary information and benefits of HBGM. They should teach the patient the proper way of monitoring and correct usage of the meter used. Most importantly, the health care providers should evaluate at regular intervals the patient’s ability for home blood glucose monitoring data to guide treatment of diabetes.

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