1. Testing your blood glucose levels regularly will help you keep your levels within target range and help you and your diabetes healthcare team to evaluate and determine the best management strategy for your diabetes.
2. Glucometers come in a variety of sizes, with different storage capacities and features. Some glucometers can also be used to check for the presence of ketone which is useful for people with type 1 diabetes or those who are otherwise susceptible to ketoacidosis.
3. The more glucose readings you take, the better it will help you guage how you are doing. A continuous glucose monitoring system may be prescribed by your healthcare team to overcome what would have been "blind spots" in the glucose profile.
Why do I need to monitor my blood glucose levels?
Testing your blood glucose levels regularly will help you keep your levels within target range and help you track how well you are doing between your visits to the doctor.
Blood glucose monitoring will:
1. Provide a measurement of your blood glucose level at a given time.
2. Determine if you have hypoglycaemia at the moment.
3. Enable you to know how your lifestyle and medications affect your blood glucose control.
4. Help you and your diabetes healthcare team to evaluate and determine the best management strategy for your diabetes.
Which blood glucose meter (glucometer) should I use?
Glucometers (blood glucose meters) are available for sale in the retail pharmacies of hospitals and polyclinics. Glucometers come in a variety of sizes, with different storage capacities and features.
Some glucometers can also be used to check for the presence of ketone which is useful for people with type 1 diabetes or those who are otherwise susceptible to ketoacidosis.
5 Steps of blood glucose monitoring
When should I check my blood glucose levels?
Blood glucose levels can be checked pre-meals or post-meals, depending on your discussion with your diabetes healthcare team.
| Recommended Timing | Rationale |
|---|---|
| Pre Breakfast In the morning after an overnight fast (8-12 hours) before you eat or drink anything |
It determines what is going on at night, especially when coupled with a bedtime reading the night before. |
Pre-Meals To correctly interpret a pre-meal reading, the previous meal or snack must have been more than 4 hours earlier. |
It gives you a baseline reading of your blood glucose level before you eat. If you are on insulin, pre-meal readings also inform whether you have given an adequate amount of insulin for the previous meal, or if you need more insulin (if your blood glucose level is above target). Note that if you have had a snack within the last 2-4 hours prior to this reading, the reading would likely be above target. |
| Post-Meals Check 2 hours after finishing your meals. |
This gives an estimate of how much your blood glucose rises in response to certain food items. |
| Bedtime Check more than 3 hours after dinner with no supper or snacks in between. |
Checking to see what your blood glucose levels are at bedtime will help you adjust your intake at dinnertime to achieve better levels at bedtime. If you are on insulin, and your glucose level is < 6mmol/L at bedtime, you may want to consider consuming 10g of long-acting carbohydrates to prevent nocturnal hypoglycaemia. |
| 2 to 4 am | To detect night-time hypoglycaemia, especially if you have symptoms during your sleep. Sometimes you may be asked to set an alarm to test your glucose level at this time. This is particularly if nocturnal hypoglycaemia is suspected. |
What should my blood glucose targets be?
The more glucose readings you take, the better it will help you guage how you are doing.
The blood glucose targets given below are a general guide only. Check with your doctor or nurse about your individualised blood glucose targets.
If you are experiencing reccurent hypoglycaemia, you may be asked to aim for higher blood targets.
Discuss your targets with your diabetes care team.
Ways to achieve better blood glucose targets
Keeping your blood glucose levels within the target range is important to reduce the risk of diabetes-related complications. Here are some tips to help you achieve a better blood glucose reading.
1. Maintain healthy eating habits
2. Maintain an active lifestyle
3. Take your medications regularly
4. Keep a record of your blood glucose readings so you can track how you are doing
What is continuous blood glucose monitoring?
Continuous glucose monitoring systems are devices that include a sensor, a transmitter and a receiver.
A continuous glucose monitoring system samples interstitial glucose levels every few minutes, which allows for collation of all the glucose values into glucose curves.
Figure 1: A continuous glucose monitoring system collates all glucose values into glucose curves.
Each sensor is able to provide readings typically for up to 6 days. This helps to fill in the gaps of missing information from doing only intermittent capillary blood glucose readings (Figure 2a).
Continuous glucose monitoring sytems enable a more complete picture of glucose trends and patters to enable more precise insulin dose titration.
As a continuous glucose monitoring system samples glucose readings every few minutes rather than taking snapshots of the capillary glucose at any one point of time, it is able to provide information on the glucose trajectory (Figure 2b). This allows the use and healthcare team to overcome what would have been "blind spots" in the glucose profile.
Figure 2a: Self-monitoring of capillary glucose readings (mmol/L) over the course of 5 days
Figure 2b: Continuous glucose monitoring tracing over 1 day. With continuous glucose monitoring, glucose curves are generated that allow a more comprehensive view of glucose trajectories beyond capillary glucose readings, and how food/medication/exercise interact with glucose levels.
Benefits of diagnostic and real-time continuous glucose monitoring
Continuous glucose monitoring may either be retrospective for diagnostic purposes or it may be use in real-time.
Diagnostic
Diagnostic continuous glucose monitoring systems are blinded to the individual who is wearing it. It is used by the healthcare professional to:
- Detect asymptomatic or nocturnal hypoglycaemia
- Aid in titration of medications or insulin doses, or making nutritional adjustments
Real-time
1. Alerts of deviation from preset threshold
Real-time continuous glucose monitoring systems also contains alarms which can alert the user if the glucose level is rising or going below a pre-set threshold. This will allow the use to make changes to prevent or correct a high or low glucose level.
Most real-time continuous glucose monitoring requires once to twice daily blood glucose calibrations (involving finger-prick glucose tests) and each sensor lasts for 7-10 days.
2. Improves glucose control
Real-time continuous glucose monitoring has been shown to improve overall glucose control in terms of improvements to HbA1c and reduction in the frequency of hypoglycaemia, particularly in those with type 1 diabetes.
However, real-time continuous glucose monitoring needs to be use regularly for this improvement to be effected.
3. Allows for automated insulin suspension
In addition, real-time continuous glucose monitoring may be combined with insulin pump therapy to allow for automated insulin suspension in response to, or prior to, a pre-set low glucose level. It can also be used to control high glucose levels by automatically controlling delivery of basal insulin in artifical pancreas systems.
Flash glucose monitoring
Another form of glucose monitoring, known as flash glucose monitoring, consists of a sensor and a reader or smartphone.
The sensor is placed at the back of the upper arm and once inserted, may be used for up to 14 days.
Using the reader to flash acorss the snesor, the user is able to view:
- The current tissue glucose level
- The direction in which the glucose is heading
- The preceding 8 hours' trajectory
Unlike real-time continuous glucose monitoring, flash glucose monitoring does not require blood glucose (finger-stick) calibrations. However, it is unable to provide alarms, and the glucose reading is only retrieved when the use flashes the reader across the sensor.
Ref: F26
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