Understanding Glucose Monitoring Program Recap

Thank you to Laura Moran from Capital Health for speaking to our patrons in honor of Diabetes Awareness Month.  Diabetes centers around our blood glucose (sugar) and the ability to process that sugar effectively.  Therefore, monitoring your blood glucose levels is extremely important for diagnosing and treating the disease.  How and when to monitor are the most common questions related to blood glucose monitoring and you should always follow the protocols set up by your doctor or diabetes specialist.  These protocols can help determine if insulin or medication is needed to control your diabetes, identify patterns in your blood glucose movement, and even indicate more significant problems such as hyperglycemia and hypoglycemia.  The information presented here is for educational purposes only; you should always consult your doctor or diabetes specialist for medical advice.

How to Monitor

If you are instructed to start monitoring your blood sugar, you will need the following things:

• Monitor – many people can get these for free through insurance or through the manufacturer
• Test strips – most expensive part of monitoring
• Lancets – small needles to puncture skin
• Log book – logging your results, either in a book or app, can help identify patterns in your blood glucose

Generally, testing is done by drawing blood from your fingers.  Make sure to wash and dry your hands thoroughly before testing to avoid any contamination that might affect your reading.  Massage your finger to ensure good blood flow and use the lancet to prick the side of your finger tip, where there are slightly less nerve endings.  Make sure to rotate fingers to prevent developing callouses.

When you are finished testing, make sure to log your results and dispose of lancets in accordance with your local township regulations regarding needles.  You can always place used lancets in a rigid container, such as an empty bleach bottle, and tape the lid closed before disposing.  Make sure to indicate that the bottle says “Do Not Recycle” before disposing in the trash.

Other monitoring tips include:

• Keeping all testing supplies together and easily accessible
• Check expiration dates
• Monitor daily, especially when you do not feel well, and record all results
• Take action if your numbers are low/high and call your practitioner when results are out of your normal range
• Keep emergency supply of sugar if your are hyperglycemic

When to Monitor

Our blood sugar constantly fluctuates throughout the day and can be affected by what we eat, sleeping habits, stress, exercise, and medications.  Therefore, it can be difficult to figure out when to monitor your sugar.  However, there are 8 generally accepted times when you can test your blood glucose:

• Wake Up – also known as Fasting and is the most important test
• Before Breakfast – generally used when breakfast does not occur immediately after waking up
• 2 Hours After Start of Breakfast
• Before Lunch
• 2 Hours After Start of Lunch
• Before Dinner
• 2 Hours After Start of Dinner
• Bedtime

While this may seem overwhelming and confusing, these times are generally recommended so that you and your practitioner can more easily map your blood glucose rises and falls, including possible foods, activities, or medicines that may affect your results.  This is why keeping consistent and accurate logs of your readings, including information about food, medication, stress, exercise, etc. is so important.

There are now 3 widely used sampling schedules that help you and your practitioner determine when to monitor your blood glucose:

1. Twice Daily Monitoring – This is more efficient at finding patterns, especially related to food intake.  4 days a week, you take 2 readings based on your food.  For example, one day you will test at breakfast and 2 hours after the start of breakfast.  Another day, you will test at lunch and 2 hours after the start of lunch.  A third day, you will test at dinner and 2 hours after the start of dinner.  The fourth day, you will test at bedtime and when your first wakeup.
2. One Daily Monitoring – You monitor your sugar once each day, either at the same interval or rotating intervals.
3. Continuous Monitoring – You place a monitoring device on your body and it will test your blood glucose every 1-10 minutes using the interstitial fluid in your skin.  This monitoring is most often used in conjunction with a mobile app that will give you real-time results and immediate advice on your current level and the direction and speed in which your blood glucose is moving.  Devices last between 7-14 days.  In order to qualify for these devices through your insurance in New Jersey, you must currently be taking insulin.

What to Monitor For

Generally, you are monitoring your blood glucose to make sure that you do not fall too low or rise too high, both of which can have adverse effects on your body and health.  For a person with diabetes, regardless of the type, your blood glucose reading should be between 80-130 before a meal and less than 180 two hours after a meal.  Additionally, your blood glucose should not rise more than 50 points after a meal, meaning that if your reading is 90 before a meal, but then is 170 two hours after a meal, that is a problem, even though you are under the maximum of 180.  You should always speak with your diabetes practitioner to determine you own personal goals based on your age, risk for hypoglycemia, and other health-related complications.

Complications

Hyperglycemia

If your blood glucose rises above 250 points and stays elevated for prolonged periods of time, even if you do not suffer from diabetes, you suffer from hyperglycemia, or too much sugar in your blood.  Symptoms can include:

• blurry vision
• increased thirst and need to urinate
• feeling tired or ill
• recurring skin, gum, or bladder infections
• dry and itchy skin
• unexpected weight loss
• slow-healing cuts or bruises
• loss of feeling in feet or tingling feet

Essentially your body is trying to pull as much water from organs and cells to try to dilute your blood and flush out the excess sugar.  Many things can cause hyperglycemia, including food, illnesses, misusing medication, and stress.  Adjusting your diet and managing stress are easy ways to help lower your blood glucose and avoid hyperglycemia.

Hypoglycemia

If you blood glucose falls below 70 points, you will suffer from hypoglycemia.  Individuals with diabetes are at a much greater risk of experiencing the symptoms and complications related to hypoglycemia than someone who does not suffer from diabetes.  Symptoms can include:

• irritability
• confusion or trouble concentrating
• headache
• dizziness
• heart palpitations
• shaky
• excessive sweating

Generally, ingesting sugar will help so if you believe you are experiencing hypoglycemia, follow the 15/15 Rule:

1. Start with 15 grams of rapid acting carbohydrates (1 serving), 30 grams if blood glucose is below 50
   • Soda, juice, glucose tablets
2. Recheck your blood sugar 15 minutes later
3. If still under 70, retreat with another 15 grams of rapid acting carbohydrates
4. Recheck your blood sugar 15 minutes later
5. If still under 70, call 911

More Information

As mentioned at the beginning of this post, always consult with a health care professional before starting any blood glucose monitoring regimen or diabetes treatment.  For more information about diabetes and services available through Capital Health, please visit https://www.capitalhealth.org/medical-services/diabetes-education or contact Laura at lmoran@capitalhealth.org.  To view a recording of the webinar, please visit https://youtu.be/x3VT_UrYATM.  Links to the handouts can be found below:

• Hypoglycemia and Hyperglycemia Fact Sheet
• Home Glucose Monitoring Record