Self Monitoring of Blood Glucose

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SMBG

Research shows keeping blood-glucose close to normal reduces diabetes complications. For better diabetes care, you need to monitor the glucose level within the target range.

What is a blood glucose test? A blood glucose test measures the quantity of glucose or sugar in your bloodstream. The result can help determine how well your diabetes is being managed or need any modification. Checking your blood glucose provide the freedom of choices, the confidence to learn, and the motivation to keep striving to do better.

SMBG! You need to learn! What does it mean? What sugar level means? How to use it? When to check? How to record?

What are the tests for blood-glucose assessment?

  1. Use a glucose monitor to test glucose level at home called self-monitoring of blood-glucose (SMBG).
  2. The A1C test gives an average blood-glucose level over the last three months. It is the best way to know your overall diabetes control performance. This test otherwise called as hemoglobin A1C or HbA1C.

For effective diabetes treatment, you need to use both the A1C and SMBG to get a complete picture of blood-glucose control.

What is Self-Monitoring of Blood Glucose?

Glucose readings are just BS numbers, not a judgment of your ability to manage your diabetes. Think of your test results as a check, not ability.

Self-Monitoring blood sugar (or glucose) is a simple blood test lets you know how well you are controlling your diabetes. Additionally, it helps us providing information required to make any correction in the diabetes treatment for achieving healthy blood sugar level.

Self-monitoring blood-glucose helps to learn how food, physical activity, and medicine affect the glucose levels.

SMBG is like an elephant just sat down on one side of the see-saw delicately balancing carbs and insulin.

Who should self-monitor their blood glucose level? People who may benefit from self-monitoring of blood glucose include all type 1 diabetes and those who are taking insulin, pregnant women, struggling to control their blood-glucose levels, experiencing frequent asymptomatic hypoglycemia, or ketones.

Why should you monitor your blood sugar at home? You need to know what affects your blood sugar level; taking food (it raises), medicine or insulin (it reduces), exercise (it lower), and stress (erotic variation). Monitoring help provides details about how your choices of food, activity levels, illness, or medications influence your blood sugar levels.

What are the supplies you need for self-monitoring blood glucose? Glucometer, Glucose strips, Pricking device (Lancets), Log book, and Drop of patient blood!

  1. User manuals, it provides information regarding the apparatus (lancing device or glucose monitor). After going through it, place it safely so that when you have doubted it may clarify it.
  2. Alcohol wipes or soap & water to clean fingers or another testing site, this helps to avoid measurement errors.
  3. Lancing device with a lancet for pricking finger to get small blood drop for the test strip. Many lancing devices have a dial to select the depth of needle to prick. If you are getting insufficient blood, then dial the number up to go deeper prick or do otherwise.
  4. The test strip will receive the blood sample and convert it into meter readable form.
  5. Blood glucose meter helps to measure blood glucose level.
  6. Control solution is used to checks test strip & meter accuracy. The amount of glucose in the control solution is known. The monitor reading using the control solution should match with the control solution reading. When the result does not fall into the range, this may indicate the test strip or control solution is expired/damaged, or meter is not correctly calibrated. You should contact the meter manufacturer for assistance.
  7. Warranty card & Bill should keep securely, if there is any defect occurs to the meter, then you need this for free repair or replacement.

What should you do after testing? Even if your meter has a memory to store BS numbers; you should keep a log of your results that include dates, times and other information that could affect your level.

How long do I need to monitor my blood glucose? Diabetes is a chronic condition and not curable. So blood glucose monitoring is always required for proper diabetes management. However, you can reduce the number of tests, if your blood sugar is within the target range.

What can I do with my results? Note down your blood glucose results in a proper log book and review with your health care team. Alternatively, you can print your results from your diabetes management software.

My meter display error message! What to do? Review your meter’s user manual for specific error codes and try their suggested solution. Confirm whether you used the right amount of blood and placed correct part of the strip. Contact the manufacturer (phone number available in the manual), diabetes educator, your diabetes friend, or online community members for suggestions.

When does blood sugar spike? The idea of testing is not to catch your spike; it may occur from 30 minutes to 3 hours after eating based on the food you ate and you digestive strength. Your blood glucose normally stabilizes at about 2 hours that is why testing 2 hours after food is suggested. If the 2-hour testing number is on the higher side, then you should modify what you ate for that meal. It is advisable to reduce the amount of starchy carbs in it.

What is the correct way to prick?

Clean your hands in a running water with soap or use an alcohol wipe, dry your fingers, warm your hands by rubbing together, prick on the side of your finger (switch fingers regularly), and use a fresh lancet each time.

Tips for proper Lancing procedure

  1. Clean the site with warm, soapy water and dry. You know, food residue can introduce false high blood sugar reading.
  2. Lancing device uses lancet to obtain blood by pricking the skin. It should be thin and sharp for no or less painful. You should not clean or reuse lancets because they quickly become blunt.
  3. Adjust the depth setting on the lancing device to control the penetration based on the size of blood sample your meter require. Most meters require very small blood drop less than that of a teardrop.
  4. Hold the lancing device firmly, but not with force. You can use finger sides as they are less painful.
  5. Many meters allow alternate test sites (upper arms and thighs). However, fingertips or the outer palm are more accurate.
  6. Obtain blood sample by gentle squeeze (milking) from the base of the finger to the tip. Don’t put pressure directly on the lanced site.
  7. Disposal of lancets and other testing supplies should be in accordance with your local laws for sharps. A hard plastic container with a screw top can be disposed of in the household trash.

Can’t get blood out of your finger? Then place your finger under warm water for few seconds, hang hands down, squeeze the finger gently, increase the picking depth in the lancing device, and always use a new lancet every time you check BS.

Does pricking hurt you too much? You can decrease the lancing device pricking depth setting by 1 level, every time uses the new lancet, try a thinner lancet, change lancing device, use fingertip sides (instead of fingertip pad), and use alternative sites if possible.

Is it possible to use any other site for testing other than fingertip? Yes, some blood glucose meters allow you to use blood from alternative sites. Alternative sites for testing are the upper arm, forearm, base of thumb and thigh. Usually, blood glucose from your fingertip and from your alternative site may vary specifically when blood glucose is changing quickly, that is after a meal, after a dose of insulin or during or after exercise.

Can I use the alternative site for all of my testings? No, alternate site testing should be used only when your blood sugar is stable; immediately before a meal, after fasting, and before bedtime. Always check from your fingertip, when blood sugar is unstable; after meals, exercise, insulin, or whenever you feel BS might be falling.

What is a target blood sugar range?

Criteria for individualizing your target blood-glucose range: How long you have diabetes? What is your life expectancy? What are the other conditions you have, such as blood pressure, cholesterol, etc.? Do you have any cardiovascular condition? Do you have an asymptomatic low blood-glucose level?

As a general rule,

  • Before a meal (Fasting): your blood sugar should be within 70–130 mg/dl (3.89 to 7.23 mmol/l),
  • Post prandial: number after two hours of meals should be less than 180 mg/dl (10 mmol/l),
  • Random Blood Sugar: 24/7 hours of the day; test done at any time of the day should be within 140 to 199 mg/dl.
  • At bedtime is 100 to 140 mg/dl (5.56 to 7.78 mmol/l)

However, it is always better to maintain normal healthy blood sugar range; it is the blood sugar range of a non-diabetes healthy individual.

What to do if your numbers are too low? If you are experiencing symptoms such as shaky, nausea, nervous, irritable, hungry, sweaty, headache, weakness, and drowsy then you may have hypoglycemia!

What to do if your numbers are too high? If you are experiencing symptoms such as feeling thirsty, tired, and frequent urination then you may have hyperglycemia!

When do you need a change in treatment? If your pre-meal blood-glucose is consistently below 70 mg/dl (3.89 mmol/l) or above 140 mg/dl (7.78 mmol/l). Alternatively, your bedtime range is steadily lower than 100 mg/dl (5.56 mmol/l) or higher than 160 mg/dl (8.89 mmol/l). Then you properly need to modify your treatment regimen, consult your doctor.

How often should I monitor my blood glucose level?

Some studies have found more often self-monitoring blood glucose (SMBG) with a conventional blood sugar meter, the better their glycosylated hemoglobin (HbA1c) levels.

American Diabetes Association survey found "21% of adults with T1D never checked their blood glucose. Of those with insulin-treated T2D, 47% never monitored, and among those with T2D who were not using insulin, 76% never checked.''

How often should diabetes type 2 tests their blood-glucose level? Type 2 diabetes treating with oral medications should measure your blood-glucose level once or twice a week. It is preferable to test either before meals or after 90 minutes of a meal. However, if you are on insulin instead of oral medication (or in addition to oral medication), then your blood-glucose measurement will be more frequent consult your doctor.

SMBG & Type 2 Diabetes: SMBG is for patients with non-insulin-treated type 2 diabetes who are struggling for control. For others, benefits seem minimal.

Reference: General practice psychiatry, Volume 42, No.9, September 2013 Pages 646-650.

How often should a diabetes type 1 have to test their blood-glucose level? Some individuals are testing their blood glucose once or twice daily, while others do it four or five times.

Type 1 diabetes should measure their blood-glucose levels before every meal and 90 minutes after meals. Testing in the morning, during the wake up (before taking any food) help provides you how much insulin you need.

For best diabetes management, people with Type 1 diabetes should monitor six or seven times a day; however, a person whose Type 1 diabetes is in stable control can monitor four times a day.

For example, if your post-breakfast number is constantly within the target, then you can skip that reading.

Seven Points chart system where you can fill your blood glucometer readings for fasting or before breakfast reading, 2 hours after breakfast, before lunch, 2 hours after lunch, before dinner, 2 hours after dinner or bedtime, and at mid night 3.00 AM. Additionally, the chart has comment column to note down changes in food, insulin dose or any other changes that affect the glucose level. This seven point SMBG covers an entire day of glucose fluctuations, still not as accurate as continuous glucose monitor (CGM).

If your blood sugar level is uncontrolled, then you may require more frequent SMBG. Also if you are pregnant, then more frequent monitoring of blood glucose helps a lot.

A fasting blood sugar reading before you eat or drink anything, gives you a starting point for the day and to determine how well the night BS. If your readings are consistently higher, then you are advised to check blood sugar at 3 AM; the high result may suggest dawn phenomenon and low may suggest Somogyi effect.

Other important occasions you need to test your blood glucose level are:

  1. Before and every 2 hours during the long drive.
  2. Before, during and after heavy exercise.
  3. During illness
  4. Under heavy stress.
  5. Sleep deprived.

5 Tips for proper SMBG testing

  1. Read instructions carefully. Glucose meters and test strips come with instructions for use in the user manual. Read the instruction carefully, for proper use. It also includes a phone number to contact the manufacturer.
  2. Meter and test strips should handle with clean, dry hands. Keep meter and supplies in a cool, dry area; not in the car or the sunlight. To comparatively test the meter accuracy; you can carry the meter to the office visit.
  3. Use only the test strips recommended for your glucose meter; they are unique for each meter. Otherwise, the meter may give false or inaccurate results. Test strips are for single use, discard after use. Test strips must be kept in the original canister because moisture can affect it and the containers should keep closed. Check for expiry date.
  4. Factors that may affect your blood glucose reading are the number of red blood cells in the blood; uric acid, glutathione, and vitamin C present in the blood.
  5. Perform quality-control checks by using control solutions to ensure the test strips and meter are working properly. Do this every time you begin a new bottle of the test strip or if you doubt the accuracy of the results.

10+ Benefits of self-monitoring blood glucose

A study published in Diabetes Care stated, “Self-monitoring of blood glucose (SMBG) has been considered a key component of patient management.

Monitoring your blood glucose provides useful information to answer these important questions:

  1. SMBG protect patients by allowing them to confirm and treat hypoglycemia or hyperglycemia early.
  2. SMBG facilitates therapeutic adjustments to achieve long-term A1C goals.
  3. SMBG helps motivate patients toward a healthier lifestyle.
  4. Whether you need to take action to correct blood glucose?
  5. Help you learn how do you correct any out-of-target blood glucose level?
  6. Help understand, which foods are best for your blood-glucose control as well as which foods are most harmful to your diabetes control.
  7. Help to understand, what physical activity and the duration of the activity is right for you so that you can avoid activities that have ill effects on your health.
  8. What changes can you make? The way you eat, medication or increase in activity. For example, if your blood glucose was within target range before certain food and out of range a few hours later, then you should eat that food less, exercise more or give more insulin next time.
  9. What causes out-of-target blood glucose? Whether you eat more, skip exercise, sickness, medication not working properly, or any change in your routine.
  10. SMBG offers more freedom to choices to choose your diet, exercise, and treatment.

Once your master how your blood glucose is influencing by different factors then naturally your anxiety lowered regarding the blood-glucose level, thus chances are more for efficient control.

How do you keep BS record?

You can keep your blood glucose record in your self-monitoring blood glucose (SMBG) chart. The SMBG chart can contain nine columns; date, fasting or pre-breakfast BS, 2 hours post-breakfast BS, pre-launch BS, 2 hours post-lunch BS, pre-dinner BS, 2-hour post-dinner BS, BS at 3 AM, and comments. Rows with specific dates will provide you the comprehensive detail of your BS at different occasions.

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