Blood Glucose

 

blood glucose machine

A question that commonly arises for the Diabetes team is in regards to self monitoring blood glucose levels.  Following a change in guidelines we have created a leaflet that explains who should be testing their blood glucose levels and how to reduce wastage. This leaflet can be downloaded and printed at home so that we can help empower patients into making the right choices. Please read through the case studies below that will help further explain who should be testing and how to test appropriately.

medication2

Stan takes Metformin tablets to help control his diabetes

Stan has had Type 2 diabetes for four years. When he was diagnosed he was provided with a blood glucose meter from his GP surgery and advised to test on a couple of days a week.

For the past three annual review appointments he’s been pleased with his HbA1c result (his average blood glucose over the previous 2-3 months). His practice nurse was interested to know how often he checked his blood glucose and how he used the results. He explained he tested every morning, a task he found quite frustrating bearing in mind the results were more or less the same. He didn’t particularly use the results but felt it was expected of him.

The nurse explained that his overall blood glucose control was being monitoring by the six-monthly HbA1c blood tests and that his Metformin tablets were not likely to cause abnormally low blood glucose levels.

After hearing this Stan decided not to continue monitoring his blood glucose at home and was delighted with the outcome, knowing his diabetes was still being closely monitored.

Maria takes Metformin and Gliclazide to help control her diabetes

Maria has had type 2 diabetes for three years. Since her diagnosis she has taken Metformin tablets twice a day. Maria has always attended her annual reviews and her HbA1c results (her average blood glucose over the previous two to three months) have always been good, which meant that Maria did not have to test her own blood glucose levels at home.

However, her last HbA1c result had increased and was now above her target level. At her Care Planning appointment and during discussion with her nurse, she agreed to take Gliclazide as well as her Metformin to help control her diabetes.

As Gliclazide encourages the pancreas to produce more insulin, there is an increased risk of blood glucose levels falling below 4mmols/mol (normal range 4-9mmols/mol). Having explained the risk of hypoglycaemia, Maria decided to start checking her own blood glucose levels at home.

She was provided with a meter, test strips and a sharps bin for safe needle disposal and understood the need to test her blood glucose levels in relation to the following:

  • How lifestyle choices can affect blood glucose levels e.g. smoking, physical activity, diet. Local X-PERT courses explain more.
  • To work out if the dose of her tablets needed to be increased.
  • To make sure she is not having blood glucose readings below 4mmols/l whiledriving and to monitor if driving for long periods.
  • To monitor her blood glucose during periods of illness.

Maria was also re-assured that her HbA1c blood test would be checked every three months until her diabetes control had settled.

Alan takes Metformin and Pioglitazone to control his diabetes

Alan has had Type 2 diabetes for seven years. He has taken Metformin since his diagnosis and agreed to start Pioglitazone three years ago. Since then his diabetes control has been within his agreed target. His six monthly HbA1c blood test has stayed below 53mmol/mol (7%). The HbA1c blood test is the average blood glucose over the past two to three months. He has always been very happy with this and felt that he has managed his diabetes well.

At his last annual review Alan mentioned his friend, who had recently been diagnosed with Type 2 diabetes, had been given a meter to test his blood glucose levels at home. He questioned why he had never been given one.

Alan and his nurse discussed that his blood glucose levels were being monitored using the HbA1c blood test and that they had remained within his target level for the past three years. Alan already knew that the medication he takes to help control his diabetes were not likely to cause a serious drop in his blood glucose levels (hypoglycaemia).

The nurse explained that Alan could have blood glucose monitoring strips on an acute prescription if he wanted to see how his lifestyle and diet affected his blood glucose level. He could use this information to make appropriate changes. After this discussion, Alan felt that there was no need for him to self monitor and he was happy with the use of the six monthly HbA1c blood tests to monitor his control.

Stephen injects insulin four times a day (basal bolus regime)

Stephen is a 21 year old who works in the City. He was diagnosed with Type 1 diabetes 14 years ago. Stephen uses an insulin regime which includes injecting insulin four times a day (basal bolus regime).

As Stephen leads a very busy and active lifestyle he is used to adjusting his insulin dose regularly according to his activity levels, his food intake and his blood glucose levels. He has learnt how to manage his diabetes effectively since attending a local structured education course – DAFNE.

He recently had a few problems obtaining enough test strips from his GP and arranged an appointment to discuss further.

By discussing with his GP how he uses his blood glucose readings to manage and maintain his diabetes control so successfully, his GP understood Stephen often has to test his blood glucose up to six times a day. It was agreed that he would require at least 180 strips per month.

His prescription was altered to 200 strips (four boxes) per month.

Stephen also agreed with his GP that he would not stock pile his test strips and only order as and when he required them.

Michelle takes Metformin and a night time insulin injection at night

Michelle has had Type 2 diabetes for the last eight years. She was recently started on insulin, 12 units before bed and was advised to continue taking Metformin tablets twice a day. She was not testing her blood glucose levels previously to this but when she started insulin she understood the benefits of testing her blood glucose at home.

Michelle planned to use her monitoring results to:

  • Help adjust her insulin dose, by testing her blood glucose level early in  the morning and once again during the day. She is able to monitor how well the insulin dose is controlling her blood glucose levels and adjust this if necessary. Once blood glucose levels remain stable she may be able to reduce how often she tests.
  • Learn about lifestyle changes. Following a structured education such as X-PERT.
  • Be aware of driving regulations and how to safely deal with these.  
  • Monitor blood glucose levels.
  • Monitor if feeling unwell.

Michelle was reassured that her HbA1c would be monitored on a three monthly basis until her diabetes was stabilised.

After reading through our case studies and the leaflet, we hope that you, as the patient, are more informed about who should be testing and when. However if you are still experiencing difficulty understanding or you feel that after reading these you should be testing but are not please make an appointment to go back and see your GP.

Block A Level One, Queen Mary's Hospital, Frognal Avenue, Sidcup, Kent, DA14 6LT Diabetes Queries: 020 8269 3419