Self-monitoring Of Blood Glucose

Self-monitoring of blood sugar is the approach by which the person with diabetes measures their blood sugar (blood sugar) level by themselves using a blood glucose meter (glucometer). Then, based on the results obtained, she can adjust or check the effect of her treatment (diet, physical activity, insulin, antidiabetics, stress management). In a context of self-management of diabetes, self-monitoring makes it possible to maintain blood sugar levels as close as possible to target values. 

Self-monitoring, a constraint?

People with diabetes may perceive self-monitoring as a constraint for several reasons: material to carry, injecting themselves sometimes several times a day, feeling of frustration in the face of certain unexpected results. However, when the person uses self-monitoring as recommended and understands the benefits of this approach, they see them as more of an ally. 

Self-monitoring allows you:

Check the impact of the different treatment components on your blood sugar and make adjustments, if necessary.

To supplement the information provided by glycated hemoglobin (A1c).

Identify, treat without delay and prevent hypoglycemia as well as hyperglycemia.

To develop a feeling of confidence, security and autonomy.

Importance of teaching

To reap the benefits of self-monitoring, it is essential that you receive instruction from a healthcare professional. This teaching should include the following elements:

The technical aspects of self-monitoring;

Blood sugar targets;

When and how often to test blood sugar;

The measures to be taken according to the results obtained;

Reassessment of timing and frequency of self-monitoring every 3 to 6 months depending on clinical condition and results.

Without this information, self-monitoring of blood sugar will not offer its full potential, which could affect your motivation and the achievement of your goals.

How to measure your blood sugar?

The first step is to meet with a healthcare professional. After having identified your characteristics and your needs, he will suggest a blood glucose meter that you can obtain at a pharmacy as well as any other equipment necessary for self-monitoring: lancets (needles), lancing device (to take the blood sample), strips reagents and facial tissues. 

Then, you will learn how to properly measure your blood sugar:

Wash your hands with soapy water and dry them well.

Insert a test strip into the blood glucose meter.

Insert a lancet into the lancing device.

Prick the tip of the finger (side part).

Gently squeeze your fingertip as needed.

Contact the blood with the test strip.

Wait a few seconds (variable time depending on the reader).

Read and write the result in a notebook or save it in the blood glucose meter.

Time and frequency of self-monitoring

The timing and frequency of self-monitoring is determined by the type of diabetes, the treatment prescribed, the risk of hypoglycemia, and the person’s ability to understand the concepts being taught. They therefore vary from person to person. 

Situation Recommended timing and frequency of self-monitoring

Person being treated with four or more insulin injections per day or with an insulin pump At least 4 blood sugar readings per day (before meals, at bedtime and in certain circumstances, 2 hours after meals and in any other situation where there is a risk of hypoglycemia)

Person with type 2 diabetes treated with only one injection of insulin per day and anti-diabetic drugs At least 1 blood sugar test per day at different times of the day (on an empty stomach, before meals, 2 hours after meals or at bedtime)

Person with type 2 diabetes treated with insulin secretagogues * When symptoms of hypoglycemia occur

Person with type 2 diabetes treated with antidiabetic drugs without risk of hypoglycemia or with lifestyle habits Usually not required, except in special situations

* gliclazide (Diamicron MD  and Diamicron MR MD ), glimepiride (Amaryl MD ), glyburide (Diabeta MD ), repaglinide (GlucoNorm MD ).

Some special situations may require that the person with diabetes measure their blood sugar more frequently. These situations are generally as follows and should be discussed with the healthcare team:

• A recent diagnosis of diabetes;
• The start of a new treatment;
• Failure to reach blood sugar targets;
• Planning a pregnancy or an ongoing pregnancy;
• The practice of a profession requiring increased monitoring of blood sugar levels;
• A medical condition that can affect blood sugar control.  

How to ensure the accuracy of the results?

You can check that your meter is working properly using the control solution that is usually supplied with it. If not, it is usually available from the pharmacist or the company that makes the meter. In addition, it is recommended that you check the accuracy of the results displayed by your blood glucose meter at least once a year. This is done by comparing the results of a blood sugar test taken on your glucose meter with a blood sugar test taken at the same time in the laboratory, when you are fasting. Consult a healthcare practitioner to find out the acceptable difference between the two. Also, do not forget to respect the conditions of use of the glucometer.

In order not to distort the results, it is also necessary to ensure the good condition of the strips and of the blood glucose meter in general:

The expiration date on the test strip container has not been reached or passed

The test strip container was not left open after taking a test strip

The strips are in their original container

The strips have been stored away from moisture and at a temperature between 4 and 30 degrees Celsius

The strips have not been contaminated with dust or other substances 

There is no dust or dried blood in the opening for the test strip

The blood glucose meter has not been left in direct contact with sunlight

The blood glucose meter has not been exposed to moisture or to a temperature lower than 5 degrees Celsius or higher than 30 degrees Celsius.

The blood glucose meter has not been dropped or come in contact with liquid 

Prevention of infections

In addition to hand washing, it is important to use a new lancet for each test and to dispose of the used lancet and test strip in a biomedical waste container available at pharmacies.

Conclusion

Self-monitoring of blood sugar is a tool for the self-control of diabetes. However, measurements taken more often and at times other than recommended or without instruction will not necessarily provide clinical benefit. For some people, self-monitoring can even become a source of stress. Thus, it is important to ask yourself how often you measure your blood sugar, how you interpret the results, the actions you take in response to the results obtained and your feeling of autonomy vis-à-vis diabetes. Do not hesitate to discuss it with your care team.