Self-Monitoring of Blood Glucose

Self-Monitoring of Blood Glucose
“My Doctor Says
I Should Monitor My Blood Glucose...”
What Does This Mean?
BD Getting Started™
Self-Monitoring of Blood Glucose
Daily Blood Sugar Monitoring
lows. Short term (daily) control is key to achieving long term
When you have diabetes, managing your blood glucose
level is the most important thing you can do to feel your
best and prevent long-term complications. Blood glucose
monitoring (BGM) is a way for you to take charge of your
health by checking your blood glucose
with a blood glucose meter.
Checking for long term glucose control in your
doctor’s office and at home
Checking at home or “on the go”
Managing your diabetes is a combination
of healthy eating, being active, and, if
needed, taking medications. You can play
a big role in managing your diabetes by
monitoring (checking) your own blood
glucose levels. The information you get
from checking your blood glucose helps
you to manage your diabetes in the best
way possible. Self-Monitoring means you
check your own blood glucose at home or
on the go with a blood glucose meter. Using a blood
glucose meter tells you the level of your blood glucose at
the moment it is being checked. It also tells you the effect
of food or activity that happened one to two hours before
the blood glucose was taken. This is important because
blood glucose levels are always changing during the day
and night. You may not feel these changes until they reach
very high or very low levels. Many things can make your
blood glucose go up or down. Checking your blood sugar
daily is important to keep your blood sugar in target range
as much as possible during the day and avoid highs and
Makes Blood
Glucose Go Up
• Food
• Stress
• Illness
Makes Blood
Glucose Go Down
• Exercise
• Medicine
• Eating less
Since it is difficult for you to check your blood glucose at all
times during the day and night, you will need an additional
test called A1C to give you and your doctor a more accurate
overview of your diabetes management over a longer time
The A1C (A-one-C) test
This blood test is done at the laboratory or
in your doctor’s office every 3 to 6 months.
It measures the average amount of blood
glucose that has been in your blood over
the last 3 months. Both day–to–day
self–monitoring and periodic A1C monitoring
are necessary to keep careful track of your
blood glucose control. A1C testing is now
available at home. This simple test can help
you gauge your progress between visits.
For more information about the A1C test, read the
BD brochure, “A1C What’s your Number?”.
eAG (estimated Average Glucose)
This new number is directly related to A1C, but uses the
same values and units that you see when you check your
blood glucose with a meter or receive a glucose result on a
lab report. It is another way to look at diabetes control
over a 3 month period of time.
What is so important about my average?
Your estimated average glucose is strongly linked to your
risk of developing long-term complications of diabetes. The
closer your average is to "normal" (around 70-130 mg/dL),
the better off you are. Most blood glucose meters tell you
your average blood glucose over the past 14 days.
WHY Do I Need to Check My
Blood Glucose?
Managing your diabetes by setting
blood glucose goals
Your doctor will help you set goals,
sometimes called targets, for your blood
glucose levels. These are the ranges of
numbers that your blood glucose should
fall within most of the time. Research has shown that
keeping your blood glucose as close to your targets as
possible can prevent or slow the complications of diabetes.
Although diabetes is a condition that does not go away, it
can be managed by healthy eating, being active and, if
needed, taking medication.
How self-monitoring helps you
Checking your own blood glucose gives you the information
you need to answer these important questions:
• What is causing out-of-target blood glucose? Did you
eat too much or skip exercise? Are you sick? Is your
medication working properly? Has anything changed
in your routine?
Your tool for better management
When you self-monitor your blood glucose you are checking to see if you are staying within your targets or blood
glucose goals. If you are outside your targets, you may
need to take action. Think of your results as within your
target range, “high or low” rather than “good or bad.”
Blood Glucose Monitoring (BGM) is a useful tool that lets
you know if you need to take action or not. It puts you in
charge of the things that affect blood glucose control.
Your doctor or diabetes educator will work with you to
decide the blood glucose goals that are right for you.
The following table provides recommended target blood
glucose ranges and shows when you should take action
to get your blood glucose back on track.
• Is your blood glucose in its target ranges most of
the time?
• What is your blood glucose level — too high, too low,
or right on target?
• How can I correct an out-of-target blood glucose level?
• Do you need to take action to correct blood glucose
that is too high or low?
• What changes can you make in the way you eat, take
your medication or increase your activity that may
improve your blood glucose readings?
Note: If your blood glucose was within target range
before your favorite snack and out of range a few
hours later, you may decide to eat less, exercise
more or give more insulin next time.
When To
Take Action
Less than 100
70 to 130
If less than
70 or greater
than 130
2 hours after
Less than 130
Less than 180 If less than
70 or greater
than 200
Less than 6
Less than 7
Plasma Glucose
Before eating
If greater
than 7
American Diabetes Association. Standards of medical care in diabetes - 2010.
Diabetes Care. 2010;33(suppl 1):S18
WHEN Should I Check My Blood Glucose?
Deciding on your treatment plan
You and your doctor or diabetes educator will decide
when you need to check your blood glucose and how
often it should be done. This will depend on your
treatment plan and how often you are willing to check
your blood glucose.
The following table is designed to help you know when
to check your blood glucose.
Type of Diabetes
People who manage their diabetes
with healthy eating and exercise, have
a regular daily routine, and meet their
blood glucose goals may only need
to test once a day or a few times a week.
People who take insulin may need to
check four times a day or more.
You may need to check more often as
your treatment plan changes or you are
sick or feel stressed. When you begin to
monitor your blood glucose or if your
blood glucose is not well managed, you
may be asked to check your blood glucose
more often than usual.
This will give you and your
doctor the information
necessary to make changes
to your treatment plan.
Once you have reached your
blood glucose goals, you may
be able to reduce the number
of blood glucose checks you
do each day.
Number Of Checks
Per Day
2 to 3 insulin
injections per day
3 or more — usually
before giving an
injection and always
at bedtime
Pump therapy or
4 insulin injections
per day
4 to 8 times a day —
usually before and
after meals and always
at bedtime
Changing treatment
or routine
4 or more — usually
before giving an
injection and always
at bedtime
During illness
At least every
4 to 6 hours
2 to 3 insulin
injections per day
2 to 3 times — usually
before giving an injection
and always at bedtime
Pump therapy or
4 insulin injections
per day
4 to 8 times a day —
usually before and
after meals and always
at bedtime
Changing treatment
or routine
3 or more — always
at bedtime (Ask your
provider or diabetes
Healthy Eating
and Exercise
Ask your provider
or diabetes educator —
usually exercise
once a day
American Diabetes Association. Standards of medical care in diabetes - 2010.
Diabetes Care. 2010;33(suppl 1):S11-S61.
A commonly recommended BGM plan
Check blood glucose:
• Before meals and before taking insulin or medication
• Two hours after meals
• Before bedtime
1. A change in your usual meal plan (if you eat too
much; eat out at a restaurant; attend a special
occasion; or are sick and not eating as usual).
Note: For people who may have low blood glucose
reactions during the night, a 3:00 AM blood
glucose check may also be needed.
If you are taking insulin
Self-monitoring your blood glucose
will let you know if:
• Your food, activity and insulin
are matched
• An extra dose of insulin is needed to
bring your blood glucose to your goal
• It is safe for you to drive a car or go to sleep
because your blood glucose is too low
Note: There is a danger of losing consciousness if
your blood glucose is too low (this is
known as severe hypoglycemia). Not
everyone gets warning signs of low
blood glucose. BGM is the only sure
way to know what your blood glucose
level is at any time of day.
Change-of-routine alert!
No matter what BGM plan you have
developed with your health care team,
it is recommended that you check your
blood glucose WHENEVER you have a
change in your daily routine.
2. Possible low blood glucose reaction (you are shaky,
tired, sweaty, hungry, confused or have a headache).
3. You are sick. It is especially important to check your
blood glucose when you do not feel well. Blood
glucose usually increases when you are sick. It is a
good idea to check your blood glucose at least every
4 to 6 hours when you are sick. Calling your doctor
or health care provider with your symptoms and
blood glucose results can help the doctor decide on
the proper treatment for your illness and prevent
problems with your diabetes. For more information
about sick days, read the BD brochure, “BD Getting
Started™ Sick Days”.
4. Possible high blood glucose reaction (you are thirsty,
hungry, urinating more often, have blurred vision,
headache or feel tired).
5. Before, during and/or after exercise.
6. You are not feeling well.
7. Before driving or driving for long periods of time.
Note: You might also increase the number of times
you check your blood glucose each day whenever
you and your health care team want to improve your
overall blood glucose levels, or any time you want to
know your blood glucose level.
HOW Do I Check My Blood Glucose?
Find the right meter
2. Prick the site with a lancing device.
Your diabetes educator will help you choose the glucose
meter that is best for you, teach you how to use it and how
to record the results. Several different meters and supplies
are available to help you check your blood glucose levels.
3. Put a little drop of blood on a test strip.
4. Follow the instructions that come with your meter for
inserting the test strip and using the blood glucose
5. In seconds, the blood glucose meter reads your blood
glucose level.
Important features to consider when selecting a blood
glucose meter:
• Fast results
• Small blood sample size
• Convenient size of meter
• Easy-to-read display numbers
• Ability to check blood glucose
in other places besides finger
• Data management (such as tracking date
and time of blood glucose results)
• Cost of supplies and insurance coverage
• Ease of using the meter and strips
• Whether or not the meter requires coding
• Impact of interfering substances on meter accuracy
(ask your Health Care Provider)
Steps to follow:
Checking your blood glucose is a simple process using a
lancing device, lancet, test strip and a meter. Your diabetes
educator will teach you how to do this with the blood
glucose meter you have chosen. The following are general
instructions for using a blood glucose meter. Check to see
if your meter needs to be coded with your strips before
using. Not all meters require coding.
with alcohol. If you are using alcohol, let it dry
before you prick your finger.
General instructions for using a blood glucose meter:
1. Wash your hands or clean your finger or other site
Supplies you will use:
1. Blood glucose meter — reads blood
2. Test strip — collects blood sample.
3. Lancet or small needle — fits into lancing
device, pricks finger, and provides small
drop of blood for glucose strip.
4. Lancing device — pricks finger when
button is pressed. Most devices have
dials to select how deep the needle
goes into the skin. Start with middle
depth. If you get more blood than
needed, dial the number down so the lancet does not
go as deep. If you get less blood, dial the number up
so lancet goes deeper.
5. Alcohol wipes or soap and water — to clean fingers
or other testing site.
6. Control solution — checks test strip for accuracy. The
amount of glucose in the control solution is already
known. When placed on a test strip, value should
match control solution value on bottle, package of
strips or package insert that came with your strips. If
the result does not fall into the printed range, this may
mean the strip or control solution is expired, damaged,
has not been properly stored or has not been correctly
calibrated (measured). You should call the company
who makes the meter
for instructions
if this happens.
7. User manual — provides
information about your
meter. After reading, place in safe place so that you
can find it when you have a question about your
8. Warranty card or papers — complete, make file copy
and send in immediately.
Tips for Proper Use
Read instructions carefully. Glucose meters and test strips
come with instructions for use. Your user manual should
also include a phone number that you can use to contact
the manufacturer.
Use the test strips that are recommended for your glucose
meter. It is important to use only the test strips that are
specified for your glucose meter. Otherwise, the device
may fail to give results or may give inaccurate results.
Know the factors that affect meter accuracy.
These may include:
• The amount of red blood cells (hematocrit) in the blood
• Other substances present in the blood such as uric
acid, glutathione, and vitamin C
• Altitude, temperature, and humidity
Perform quality-control checks. Use control solutions
to ensure that the test strips and meter are working
together properly. Some meters may also provide
electronic test strips that induce a signal to indicate if
the meter (and only the meter) is working correctly.
Perform a quality control test each time you begin a
new bottle of test strips or when you question the
accuracy of the results.
Ask your health care provider to watch you test yourself.
He or she can tell you if you are using the meter correctly.
Know when and how to clean your meter. Some meters
need regular cleaning. Others don't need regular cleaning,
but contain electronic alerts indicating when you should
clean them. You should follow the directions given in the
manual on how to clean the meter.
Understand what the meter display means. The range of
glucose values can be different among meters. Be sure you
know how high and low glucose values are displayed on
your meter. Sometimes they are displayed as “LO” or "HI"
when the glucose level is beyond the range that the meter
can measure.
Alternative site testing
Some blood glucose meters allow you to use blood from
“alternative sites” to check your blood glucose. These
sites are the upper arm, forearm, base of thumb and
thigh. You should be aware that blood glucose values
from these sites may be different than the results you
will receive from a finger. The body uses the glucose in
your blood at different rates so you can test your fingertip
and your arm at the same time and get different results.
This usually happens when blood glucose is changing
quickly, after a meal, after a dose of insulin or during
or after exercise.
You should check the blood from your fingers in the
following situations:3
1. If it has been less than 2 hours after a meal, insulin
dose or exercise.
2. If you think your blood glucose is low or you have a
condition called Hypoglycemia Unawareness. This
U.S. Department of Health & Human Services. FDA resources page. Food and Drug Administration
web site.
Updated May 18, 2009.
happens because you do not have signs of low
blood glucose until your blood glucose is very low.
3. If the results you receive from the alternative site do
not agree with the way you feel.
Use blood samples from sites other than your fingers only
for testing before a meal or more than two hours after a
Troubleshooting tips for you
1. Can’t get blood out of your finger?
— Place hands under warm water
and rub together
— Hang hand down below waist
— Grasp finger near area to be
pricked and squeeze gently for three seconds
— Place finger on table or firm surface to avoid
moving while pricking
— If lancing device has dial-a-depth, increase setting
by 1 level
— Use a new lancet every time you check blood
2. Hurts too much?
— If lancing device has dial-a-depth, decrease
setting by 1 level
— Use a new lancet every time you check
blood glucose
— Try a thinner lancet or a different
lancing device
— Use sides of fingertips instead of
fingertip pad
— Try alternative test sites such as arm or thigh
— Ask diabetes educator for suggestions
3. Error message?
— Review user manual (error codes and problems
are identified in manual)
— Make sure right amount of blood is on strip
— Make sure blood is on correct part of strip
— Call manufacturer’s phone number (listed on
back of meter or in user manual)
— Ask diabetes educator for suggestions
Note: For tips with self-monitoring problems, review
your user manual, ask your diabetes educator, or
contact your meter’s manufacturer.
WHAT Should I Do With My Results?
Write your blood glucose results in a logbook and
review with your health care team, or download or print
your results from your diabetes management software
Also record:
• Date and time of test
• Insulin dose or diabetes medicine
• Whether you ate more or less than usual
• If you did any exercise
• Add comments such as “had a headache, didn’t
feel well, or felt great, etc.”
Keeping these records and going over them with your
doctor or diabetes educator will help you notice patterns
that may occur and will lead to a better understanding of
how food, exercise, stress, medications, and other events
in your life may affect your blood glucose. When you look
at the record of your blood glucose results over a period
of days, you and your doctor may be able to identify what
may have caused the readings you see.
You should not be worried about one blood glucose that
is out of range, but if there are a number of them that do
not fall into range, then you need to look for a pattern.
You want to see if the blood glucoses seem to be high or
low at the same time of day for a number of days. If you
detect such a pattern, you need to think about the activities that may have affected that blood glucose result. You
will then be able to make an informed decision about
what you can do to improve your blood glucose.
For more information about using “blood glucose
patterns” refer to BD Staying on Target™ Pattern
Management brochure at
Ask your doctor or health care provider
for specific telephone guidelines
You need to know:
1. When to call his or her office to report routine
blood glucose results.
2. When to call about high or low blood glucose.
For example, your doctor may want you to report
the following information:
— A severe low blood glucose that requires
treatment by another person
— Blood glucose consistently
running below 70 to 80 more than
2 to 3 times in a row
— More than one unexplained low
blood glucose reaction in a week
— Blood glucose consistently
higher than 300 (more than
2 to 3 days)
— If you are ill with nausea,
vomiting, diarrhea or fever
HOW Long Do I Need To
Monitor My Blood Glucose?
Diabetes is a chronic condition that does not go away.
BGM is a skill that you will always need to make sure
that your diabetes is well managed. It gives you the
information you and your doctor need to make decisions
about your treatment and daily activities in life.
Living a healthy life with diabetes
Your diabetes educator will design a treatment plan with
you that is personalized for your needs (see last page).
Self-monitoring your blood glucose as recommended by
your health care team will allow you to:
• See if your diabetes treatment plan is working
• Build the new habits necessary to help you manage
your diabetes
• Live well with the condition
BD provides this brochure for informational purposes only. It is not intended to be a
substitute for professional medical advice, diagnosis or treatment. Always seek the
advice of your physician or other qualified healthcare provider with any questions
you may have regarding a medical condition. Never disregard professional medical
advice or delay in seeking it because of something you have read in this brochure.
TREATMENT PLAN FOR:_______________________________________
Health care team:
Nurse Educator:_________________________________________________
24 hr. Emergency Telephone:_____________________________________
Fax Blood Glucose Records to:____________________________________
Email Blood Glucose Records to:__________________________________
Send Blood Glucose Records to: ________________________________
My target blood glucose ranges are:
Before a meal: ____________________________________________mg/dl.
2 hours after a meal: ______________________________________mg/dl.
Just before bedtime: ______________________________________mg/dl.
At 3:00 AM: ______________________________________________mg/dl.
My A1C (Average Blood Glucose) Goal is: ________________mg/dl.
Self-monitoring — My blood glucose levels should be checked at
the following times:
Fasting (before breakfast): _______________________________________
Two hours after breakfast: _______________________________________
Before lunch: ___________________________________________________
Two hours after lunch: __________________________________________
Before dinner: __________________________________________________
Bedtime: _______________________________________________________
3:00 AM: _____________________________________________________
1. My blood glucose is more than_______mg/dl for_________readings.
2. I experience__________ episodes of unexplained low blood glucose
(less than_____________) in one week.
3. ___________________________________________________________
Written by:
Donna M. Tomky, MS, RN, C-NP, CDE
Albuquerque, NM
We wish to acknowledge the following healthcare
professionals for reviewing this publication and
providing their valuable insights.
Virginia Peragallo-Dittko, RN, MA, CDE
Levittown, NY
Barbara J. Bodzin, RN, MSN, CDE
South Euclid, OH
Alice M. Taniguchi, RN, MPH, CDE
Honolulu, HI
1 Becton Drive
Franklin Lakes, NJ 07417
1.888.BDCARES (232.2737)
Educational Information from BD Consumer Healthcare.
BD, BD Logo and all other trademarks are the property of Becton, Dickinson and Company. ©2010 BD.
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