Monitoring Blood Glucose
In order to know how much insulin to take, you need to know what the blood glucose level is. A finger prick and a glucometer will give you this immediate information. You can determine if your glucose level is going too high or too low. You can then make adjustments with more or less insulin, food or exercise.
The goal is to regulate the blood glucose as close to normal as possible. This is a chart of the goals at different times of the day.
Insulin Therapy Blood Glucose Goals
Time
|
Ideal Glucose Level (mg/dl)
|
Acceptable Glucose Level (mg/dl)
|
|---|---|---|
Before Meals
|
70-110
|
90-130
|
One Hour After Meals
|
80-120
|
160-180
|
Two Hours After Meal
|
80-120
|
160-180
|
Bedtime
|
80-120
|
110-150
|
2 a.m.-3 a.m.
|
80-120
|
100-140
|
Tracking your blood glucose and keeping good records lets you know if you are on target, and if you should be making changes.
Meters to Monitor Blood Glucose
Before meters, patients and doctors really didn’t know what the actual blood glucose level was at any given time. Lab values were usually days old, and the urine testing gave marginal information. Now, there is a wide variety of meters on the market, that give instant (within seconds) and accurate readings of current blood glucose. Meters can be quite small (to tuck into pockets), with large numbers, and a memory with software that can be downloaded on a computer for analysis of patterns. The meter is usually free, and insurance pays for the testing strips. The inconvenience is that a tiny drop of blood must be drawn from the finger (or arm) with a lancet device. The test strip touches to blood droplet, is drawn into the meter and the results are displayed quickly. Testing must be done before each meal and in the evening, before each insulin dose. Parents usually check the child’s blood glucose in the middle of the night, or the older patient does this themselves.
How to Choose a Blood Glucose Meter
Since you will use this device repeatedly on a daily basis, you should select one that meets your preferences. It is not a forever decision—you can get a new one yearly, check with your insurance company.
Meter technology is constantly advancing; here are some things to keep in mind:
- Cost: Check with your insurance company about the cost of the test strips. Often the meter itself is free or inexpensive, but the cost of strips may inhibit your multiple testing routine if you run out at the end of the month. Ask about a second meter for backup—or to leave with the nurse at school or for the second parent to carry. Some insurance companies may dictate which meter they prefer.
- Blood Sample Size: The smaller the size, the less blood you must draw. This is important if you have calloused fingers and struggle with getting enough. A very small amount would be 0.3 microliter, and a large amount would be 3.0 microliter. This information is part the package description of the meter. However most of today’s meters use small sample sizes.
- Extreme Temperatures - Kids and Meters: Consider the environments you and your family enjoy. Do you spend time in very hot or cold environments? How well does the meter, as well as the strips, stand up to unforeseen changes in temperature. Ideally, the strips must be protected from extreme temperatures such as a hot car or a car left in the garage in freezing temperatures. Insulated bags for your diabetes gear are available.
- Size: You may want a portable meter that fits in small pockets and doesn’t take up much room in a purse or travel kit (other supplies are in there too!). The smaller the device, the smaller the screen size.
- Readability: Most of us would like bigger numbers to read; the bigger the better, particularly if you are a parent that wears glasses and may be searching in the middle of the night for your equipment. Backlighting is standard, but a great feature is a light at the test strip port so you can find it in the dark while trying not to wake a child in the middle of the night.
- Information Storage: Most meters have a memory chip and can be downloaded to your computer for charts and graphs showing your control. This can be particularly helpful to your physician or certified diabetes educator.
- Special Features: You may want a meter that speaks, or has special features for limited eyesight or hand function.
- Alternate Sites: Although the fingertip is the most accurate reading, you may want to use alternate sites. Some meters have an adapter that allows blood to be drawn from the arm or leg. However, there can be a 30-point difference between the fingers and the extremities. Use the finger when you are suspicious of a low blood sugar.
- Batteries: Does the meter use a standard battery or must you get a special kind? How long does a battery last? Be sure the meter is working properly at all times.
- Meter Coding: Check to see if your meter and strips need to be coded. There will be a control solution to calibrate the accuracy of the meter. Be sure to read the instructions, and call the 800 number if you need help. Once you open the control solution, it is good for three months. The meter will also have a lancet device. This spring loaded plastic tool will have different depths, and also different gauges of the width of the lancet. You will soon find the best size and tension to use to draw the needed amount of blood. Remember to draw the sample from the side pads of the fingers. Don’t use the tips; that will hurt!
Continuous Glucose Monitor
Technology is always forging ahead, and one of the newest inventions is the Continuous Glucose Monitor (CGM). Although not commonly used in the past, more insurance companies are covering the cost of this device. The CGM is worn around the clock, and reports blood glucose every five minutes. The data is displayed on the screen with a graph, and the trend of the readings, up or down, is easily read. Fingers must still be pricked once or twice daily to calibrate the CGM. Some people wear one for a week to analyze blood glucose patterns that are puzzling and to figure insulin dosing changes. Some “pumpers” (people on the insulin pump) wear one continuously.
Teamed up with an insulin pump, a person with diabetes has the latest in diabetes technology. The CGM is recommended for age 18 and over, but some younger people have benefited from the use. Research is moving toward an "artificial pancreas," which combines the CGM with a pump to regulate insulin with little human intervention.
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