If you've got diabetes and you're leaving your home for the day, you may check your bag for more than your wallet, keys and cell phone. Chances are you also want to bring your glucose meter. Many people with diabetes monitor their own blood sugar (glucose) levels with handy meters that test blood sugar levels using a tiny drop of blood. People with diabetes who do not adequately control high blood sugar levels run the risk of complications such as heart disease, nerve damage and blindness. And blood sugar levels that drop too low due to treatment with insulin can also lead to medical problems.

There are more than 25 types of glucose meters on the market that have been approved by the Food and Drug Administration. Input from your medical team, particularly your diabetes educator, will help you select the right meter for you. Below, Carole Mensing, a clinical diabetes nurse specialist in the Diabetes Education Program at the University of Connecticut in Farmington and the president of health care and education for the American Diabetes Association, discusses how glucose meters vary and how they can help people control their diabetes.

How do glucose meters measure blood sugar?
Generally speaking, you prick your cleaned finger with the lancet provided and place a drop of blood on a test strip that is then inserted into the meter. Some of the newer meters allow for alternative sites, such as the palm of the hand or the forearm. This is helpful for people whose fingertips get irritated, particularly folks who use their hands a lot, such as hairdressers, auto mechanics, typists or guitar players. However, the forearm is not as accurate if the blood glucose is too low, so we're cautious about that.

Test strips can come individually wrapped or in a disk or little cartridge, so you just punch a button on the machine and it automatically gets the strip ready for you. Once you place the blood on the top of the strip, the meter reads the test strip in anywhere from five seconds to 40 seconds and displays the glucose level.

Most of the meters now store the numbers so that patients get an individual number, a summary of numbers over a 14- or 30-day period, and then an average. Many of the meters store up to 1,000 test results. And many of them can have the information downloaded into the computer so that, with the appropriate software, the data can be displayed in different ways and used by patient and their medical team.

Are there other kinds of devices that people can use to measure their own blood sugar?
There are some devices that can be worn like a wristwatch that take a blood sugar reading from fluid drawn from under the skin with electrodes, rather than from blood. These devices run on disks that adhere to the skin and should be changed periodically. These devices can read levels as frequently as every 10 minutes and be worn for as long as 13 hours, and there is an alarm that goes off when blood sugar levels rise too high or fall too low. They are very helpful for pregnant mothers who want to catch low blood glucose that occurs at night. Although people will think of these devices as a replacement, they are more of a useful supplement to standard glucose monitoring because they can take so many readings.

How does self–glucose monitoring help someone control their diabetes?
It's like keeping a diary. When you work with a professional team, we look for patterns. Patients bring the history of all the blood sugar levels they've done to the appointment.

We try to determine if there are any confounding factors that might be affecting your blood sugar. For example, if someone's blood sugar is always high at noontime or in the evening, we can try to figure out if we should make any alterations in either their food or medicine that might help them keep their blood glucose in the target range at that time of day. Sometimes people forget to take their medicines, or maybe their medicine has gone bad or is outdated. The meter can serve as a good alert system to these kinds of problems.

Research tells us that if people consistently stay in the target range for their blood sugar, they can lessen the complications of diabetes. If you don't self-monitor, there is less information to work with. The more information someone can give us, the better we're able to help them problem-solve.

How often should people monitor their glucose levels?
It depends on the type of diabetes they have and which treatment plan they are using. For people with type 2 diabetes for instance, who are on meal planning alone, we might recommend at least twice daily, one test in the morning before they eat and another one perhaps two hours after a meal in the afternoon. For people with type 2 diabetes who are on oral medication or insulin, we would recommend a blood sugar test in the morning before they eat, and then one two hours after their big meal of the day. If they can do some pre- and post-meal testing on occasion, that's useful to make sure that the medicine is working and to find out if we need to make adjustments.

For someone with type 1 diabetes, we'd recommend they use their glucose meter before meals, to assist with insulin adjustment based on their target blood sugar levels and the amount of carbohydrates eaten, and two hours after meals, to see if the dose worked. Women with gestational diabetes are advised to test themselves before breakfast and one to two hours after meals if they are using diet alone to control their diabetes. They should follow the recommendations for people with type 1 diabetes if they are using insulin.

What should guide a person when selecting the best monitor for them?
Convenience and size are big issues. Some people like a real small meter they can slip in their pocketbook or their pocket and take with them. Individuals who have a problem with dexterity might prefer a larger meter or larger strips that that they can handle more easily. Some people prefer a larger meter where they can clearly see the numbers. Someone with vision problems might also prefer to have a meter that has a good contrast between light and dark in the display. There are also audio-enabled meters for visually impaired people.

Another consideration is cost. Some meters and strips are more expensive than others. The more expensive meters might have a faster testing speed, or more gadgetry, such as meters that have the test strips that load automatically.

What's considered a normal range for blood sugar levels?
We usually recommend that patients keep their blood sugars between 80 and 160 mg/dL. If it's out of that range, we recommend they test again in about 15, 20 minutes. It's important that people with diabetes understand that blood sugar fluctuates. If the blood sugar level is high or low and comes into normal range at the next testing, it's not as concerning as if it stays elevated for two or three tests in a row.

But testing can also make sure their blood sugars aren't getting too low, so that they become hypoglycemic. This is particularly a concern for people who are on insulin and oral medications that stimulate insulin production. They may be at risk for low blood sugar if they haven't eaten or if they've exercised intensely. With hypoglycemia, you often get dizzy, sweaty and shaky and lose of your control of your body functions. We really encourage people who are taking medication to test blood sugars before they drive, for example, and if the blood sugars are low, to eat something.

What are the most common mistakes people make with self-monitoring?
The biggest mistake is they don't test often enough. Other mistakes are not getting a good drop of blood or contaminating the sample by not cleaning their hands.

Is there a way to test the meter to make sure it's accurate?
Yes, each meter is supplied with a quality control system that we recommend patients use periodically. Usually it comes with a solution that has a known glucose value and you place that on a strip and compare the number on the meter to the range assigned for that fluid. If it's within that range, then the meter is accurate.

Are the meters covered by insurance?
The average meter runs about $50. They're often covered by insurance, but not always. The number of strips are covered by insurance, too, but are the number of strips may be limited depending on the insurance plan.

Why is it important that people continue to be monitored by their medical team?
I think people sometimes feel like getting a meter takes care of their diabetes for them. And that really is not the message we want to give. The meter is a tool, and people still need to see their medical team. We recommend that people with diabetes see their medical team every three to four months.

During those visits, we will draw their blood to test the blood sugar in a lab. We also do a physical exam to make sure there aren't any other problems that can occur as a result of diabetes. For example, we'll do a quick eye exam. We'll also make sure they don't have neuropathy, or nerve damage, in their legs. We might do urine testing to make sure there's no kidney involvement.

What can people who are unable to self-monitor do?
There are different groups of people who either can't afford a glucose monitor or just physically aren't able to do it themselves. We try and encourage family members and/or support systems like the Visiting Nurses Association to help the patients with blood sugar monitoring. Or we encourage these individuals to have periodic blood sugars drawn as often as they can so that we can get the information that way.

Source: Healthology.

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