DIABETES CARE – SMBG

  • What is SMBG? Why is it important for people with diabetes?
  • What are basic advantages of self-monitoring blood glucose in people with diabetes?
  • Why people with diabetes need to check their blood glucose more often at home?
  • What are the different factors may cause fluctuations in blood glucose level?
  • How often should a person with diabetes check his blood sugar level?
  • How to decide the frequency of testing and when to increase it?
  • How much is the target blood glucose levels for a person with diabetes?
  • How accurate are blood glucometers?
  • Which is the best glucometer and what factors should I keep in mind for choosing glucometer? How do we choose the best glucometer for ourselves?
  • What’s the difference between HbA1c and blood sugar?
  • What’s the difference between checking blood glucose from a glucometer and from a lab?
  • How should a sufficient drop of blood be obtained for test?
  • What should be done if one cannot take blood sample from the finger?
  • What are the factors which are responsible for inaccurate or false test results?
  • How to clean and store the glucometer?
  • How are strips of the glucometer stored?
  • What happens if enough blood has not been applied to the test strip before the countdown begins?
  • Will a low battery cause inaccurate test results?
  • How often is the glucometer battery replaced?
  • How to make sure that the glucometer meter is giving accurate results?
  • How to prevent the lancet from hurting too much?
  • If the glucometer shows an error message while checking blood sugar what should be done?
  • Is there an alternative to pricking your fingers for blood tests?
  • Is it possible that one can have normal blood glucose levels and high A1c?
What is SMBG? Why is it important for people with diabetes?

Self-Monitoring of Blood Glucose (SMBG) is checking of blood glucose with a glucometer. It is the best way for a person to take charge of one’s health and prevent long-term complications of diabetes. Checking blood sugar more often help us to learn how food, exercise, stress, and medicines affect blood sugar levels.  

It helps us understand the therapeutic regimen response to blood glucose level, so that accordingly we can adjust our dietary intake, physical activity, and insulin doses. This short term daily control plays a major role in improving the glycaemic control on a day-to-day basis, thus helping in management of diabetes.

What are basic advantages of self-monitoring blood glucose in people with diabetes?

Self-monitoring helps to:

  • It gives a quick measurement of blood glucose level
  • It determine a high or low blood glucose level
  • It shows how lifestyle and medication affect our blood glucose levels
  • It also helps the doctor and the patient assess the glycaemic control and know when to take action.
Why people with diabetes need to check their blood glucose more often at home?

People with diabetes have to make sure that their blood sugars are within normal limits. People who are on insulin or oral medication need to check blood glucose more often. This self-checking helps them know when they are having hypoglycaemia without warning signs. Accordingly they may alter their diet, activity levels and medications also. Also, in case of pregnant women, disabled person and elderly, who cannot go to the laboratory more often, SMBG helps them understand their glucose pattern. This helps in management of diabetes.

What are the different factors may cause fluctuations in blood glucose level?

Factors that affects sugars levels:

Factors which makes blood glucose go up Factors which makes blood glucose go down
Food Exercise
Stress Medicine
Illness Eating less
How often should a person with diabetes check his blood sugar level?

This often depends upon the type & duration of diabetes. The doctor recommends the ideal frequency of blood sugar check on the basis of current health status, age and level of activity.

Generally the blood sugar must be checked on the following time:

  • Before meal
  • 1 or 2 hr after meal
  • Bedtime
  • Early morning
  • Before, during or after exercise
  • Changes in routine, diet or medication/insulin
  • Feeling sick or under stress
How to decide the frequency of testing and when to increase it?

Frequency and timings of checking should be discussed with the healthcare provider who will guide you how and when to check your sugars. Those who are on insulin therapy, on multiple drugs, have complications, are pregnant, erratic sugar pattern, have illness, or recently have changed in routine, diet, physical activity, medication/insulin need to check more frequently as compared to who are on oral medications, lifestyle changes or have stable sugars.

How much is the target blood glucose levels for a person with diabetes?

Your doctor or diabetes educator will work with you to decide the blood glucose goals that are right for you. Your targets may differ according to your age, type of diabetes and condition. However, according to the guidelines (ADA) the general recommended target blood glucose levels for adults (non-pregnant) with diabetes are: fasting and pre-meals should fall in the range between 80-130 mg/dl whereas 2 hr after meals value should be between 120-180 mg/dl.  

How accurate are blood glucometers?

Blood glucometers are fairly reliable to monitor sugar values at home, if you follow proper steps of checking. The standard error for glucometers is + 10-15% which is accepted worldwide, the however certain factor may alter your readings. It is important to note that glucometers are not intended to use for initial diagnosis of diabetes but frequent monitoring in previously diagnosed cases of diabetes.

Which is the best glucometer and what factors should I keep in mind for choosing glucometer? How do we choose the best glucometer for ourselves?

There are various glucometer brands available in the market. We can consider the below factors while choosing your glucometer:

  • Cost factor
  • Ease of use and maintenance
  • Availability of test strips and other supplies
  • Special features to meet special needs
  • Information storage and retrieval
  • Customer Support facility

If the brands shortlisted by you fulfil the above criteria, you may go ahead for purchase.

What’s the difference between HbA1c and blood sugar?

Blood sugar, or glucose, is a simple sugar obtained when your body breaks down carbohydrates in food. When you test your blood with a blood glucose meter, the result is a reflection of current blood sugar levels. Whereas the HbA1c test, or A1C, shows blood glucose levels over a longer period. It shows the sugar control of the patient for the past 8 to 12 weeks.

What’s the difference between checking blood glucose from a glucometer and from a lab?

Glucometer gives a reading for capillary blood which is slightly higher as glucose present there is not fully taken up by cells whereas lab value is a venous blood. It is advisable to get laboratory test for diagnosis. However for frequent check and monitoring, a glucometer is preferred.

How should a sufficient drop of blood be obtained for test?

Thoroughly wash and dry hands, and then massage a finger to encourage blood flow. Avoid using your index finger or thumb, since you use these digits most frequently. Prick the side of the finger with a finger pricker. Squeeze or massage gently to encourage a drop of blood to form sufficient to cover test area on the strip.

What should be done if one cannot take blood sample from the finger?

You may follow these steps:

  • Place hands under warm water and rub together to improve blood flow
  • Hang hand down below the waist
  • Grasp the finger near the area to be picked and squeeze gently for three seconds
  • Place a finger on table or firm surface to avoid moving while picking
  • Use new lancet to check blood sugar, as used needle become blunt
  • After lancing, massage your finger toward the tip
  • If lancing device has dial-a-depth, one can increase setting by 1 level
What are the factors which are responsible for inaccurate or false test results?

Most blood glucose monitors are reliable and all glucometers may show slight difference in results from time to time. However, there are certain factors which may alter the readings and lead to an inaccurate result. For e.g. if there is no enough blood taken for test, meter is not calibrated properly, coding is incorrect, extra squeezing from the same finger is done, damaged and outdated strips are used, test site or fingers are not cleaned properly (dirt, food, sweat, juice, cosmetics etc. may alter the results).

How to clean and store the glucometer?

Keep the glucometer clean meter to ensure accurate results. Wipe the glucometer meter with 70% alcohol or mild detergent and allow it to dry thoroughly. Wipe the display with a soft lint-free cloth or a cotton swab, which can be moist but not wet. Do not let moisture get into the meter itself. For storage ensure that your meter is kept at room temperature to avoid damage. Avoid keeping the glucometer in humid spaces and also refrain from storing it near any electronic equipment.

How are strips of the glucometer stored?

Test strips should be kept out of very cold or hot conditions. The test strip container should be kept closed at all times since it contains a drying agent that will not work if exposed to the air.

What happens if enough blood has not been applied to the test strip before the countdown begins?

If the blood sample cannot be applied fully, before the count down begin, do not add more blood to the test strip; discard the test strip and retest. If enough blood has not been applied, you may get an inaccurate result.

Will a low battery cause inaccurate test results?

No. usually meters will still provide accurate test results with a low battery, but you should replace the battery as soon as the low battery symbol appears.

How often is the glucometer battery replaced?

The glucometer will display a battery symbol once it needs replacement. Ideally the battery goes on to perform 500 to 800 tests, however this may vary with glucometers of different brands.

How to make sure that the glucometer meter is giving accurate results?

The following quality control tests can assure you that your meter is working properly:

Test using a control solution: follow your normal blood-testing procedure, but use a liquid control solution instead of blood. Use these control solutions every time you use a new bottle of test strips or if you drop your glucometer or whenever you get unusual results. These solutions usually come with your monitor and are available at most drugstores and pharmacies. Follow package directions.

Match your reading with lab results: take the blood glucose monitor along when you visit your doctor or have an appointment for lab work. Check your blood sugar level with your meter at the same time that blood is drawn for lab tests. Then compare your meter’s reading with the lab results. Results that are within 15 percent of the lab reading are considered accurate.

If your meter isn’t working properly, contact the manufacturer of your meter and test strips.

How to prevent the lancet from hurting too much?

Follow these tips to prevent getting hurt by a lancet:

  • Decrease lancing device has dial-a-depth, setting by 1 level
  • Use a new lancet every time to check blood sugar, overused lancets become blunt and can hurt more
  • Try a thinner lancet or a different lancing device
  • Use sides of fingertips instead of fingertip pad
  • Sometimes , you can also try alternative test sites such as arm or thigh

If you still have too much pain and difficulty, ask your diabetes educator/doctor/health care provider for help.

If the glucometer shows an error message while checking blood sugar what should be done?

If the glucometer shows error message, follow these steps:

  • Review the user manual – error codes and problems are identified in manual
  • Make sure right amount of blood is on the strip
  • Correct part of the strip should get in contact with the blood
  • Check for outdated strips or low battery signals
  • Call toll-free customer care number of the glucometer manufacturer mentioned in the user manual
  • Talk to your diabetes educator/doctor/health care provider for help
Is there an alternative to pricking your fingers for blood tests?

Pricking your fingers on a daily basis can lead to tough or callused skin and may be painful. There are some meters exist which allow for alternate site testing, which is where you use an alternative part of your body like a lower arm to take blood from. But it is important to note that alternate site testing may lead to different results than you may get with finger testing as there can be a lag between blood sugar levels in the fingers and other parts of the body.

Is it possible that one can have normal blood glucose levels and high A1c?

Yes, it is possible. The blood glucose reading only represents the result at one point in time. While the A1C measures your overall control for the past 2-3 months. Frequently individuals only test their fasting blood glucose and never realize that their blood glucose is very high after eating a meal. It is important to test your blood glucose levels at varying times of the day in order to evaluate your levels before a meal and after a meal. It is also important to test blood glucose when the medication is at the highest level and lowest level. There are times when one doesn’t need the medicine, if levels are too low. However, in order to gain an understanding of your overall control it is important to test at varying times.

Also frequent low blood glucose levels may result in large excursions in blood glucose if you eat a large amount of carbohydrate to compensate for the low blood glucose your blood glucose may rise excessively. If you test your blood glucose and it still does not match you may want to speak with your physician in order to gain a better understanding of the results.

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