BLOOD SUGAR TESTING OVERVIEW If you have diabetes, you have an important role in your own medical care,

and testing your blood glucose (also called blood sugar) is an opportunity for you to take control of your health. Although diabetes is a chronic condition, it can usually be controlled with lifestyle changes and medication. The main goal of treatment is to keep blood sugar levels in the normal or nearnormal range. Checking your blood sugar is one of the best ways to know how well your diabetes treatment plan is working. Continuous glucose monitors have also become popular, especially for people who use an insulin pump. (See 'Continuous glucose monitoring' below.) A healthcare provider will periodically order a laboratory blood test to determine your blood sugar levels and hemoglobin A1c (A1C). This test gives an overall sense of how blood sugar levels are controlled since it indicates your average blood sugar level of the past two to three months (table 1). However, fine-tuning of blood sugar levels and treatment also requires that you monitor your own blood sugar levels on a day-to-day basis. Self-blood glucose monitoring allows you to know your blood glucose level at any time and helps prevent the consequences of very high or very low blood sugar. Monitoring also enables tighter blood sugar control, which decreases the long-term risks of diabetic complications. HOW TO PERFORM BLOOD SUGAR TESTING The following steps include general guidelines for testing blood sugar levels; you should get specific details for your blood glucose monitors from the package insert or your healthcare provider. Never share blood glucose monitoring equipment or fingerstick lancing devices. Sharing of this equipment could result in transmission of infection, such as hepatitis B.

Wash hands with soap and warm water. Dry hands. Prepare the lancing device by inserting a fresh lancet. Lancets that are used more than once are not as sharp as a new lancet, and can cause more pain and injury to the skin. Prepare the blood glucose meter and test strip (instructions for this depend upon the type of glucose meter used). Use the lancing device to obtain a small drop of blood from your fingertip or alternate site (like the skin of the forearm) (picture 1). Alternate sites are often less painful than the fingertip. However, results from alternate sites are not as accurate as fingertip samples when the blood glucose is rising or falling rapidly (picture 2). If you have difficulty getting a good drop of blood from the fingertip, try rinsing your fingers with warm water, shaking the hand below the waist, or squeezing ("milking") the fingertip. Apply the blood drop to the test strip in the blood glucose meter. The results will be displayed on the meter after several seconds. Dispose of the used lancet in a puncture-resistant sharps container (not in household trash).

FREQUENCY OF BLOOD SUGAR TESTING Studies have proven that people with type 1 and 2 diabetes who maintain normal or near normal blood sugar levels have a lower risk of diabetes-related complications than those who have high blood sugar levels. How frequently you test will depend upon the type of diabetes you have (1 or 2) and which treatment(s) you use (insulin versus oral medications or lifestyle changes). Type 1 diabetes For people with type 1 diabetes, frequent testing is the only way to safely and effectively manage blood sugar levels. (See "Patient information: Diabetes mellitus type 1: Overview".) Most people need to test at least four times per day. If you use an insulin pump, give three or more insulin injections per day, or are a women with type 1 diabetes who is pregnant, you may need to test as many as seven times per day or more. (See "Patient information: Care during pregnancy for women with type 1 or 2 diabetes mellitus".) People who test frequently, especially those using intensive insulin therapy, may consider purchasing several blood glucose monitors to keep at home, work, school, or in a purse or backpack. This allows easier access to testing equipment, which can increase testing frequency and therefore improve blood sugar control. Type 2 diabetes Blood sugar monitoring is also important for people with type 2 diabetes. The recommendations for how often you should test are based upon individual factors such as type of treatment (diet versus oral medication versus insulin), level of hemoglobin A1c (A1C), and treatment goals. A healthcare provider can help you determine how frequently to test. (See "Patient information: Diabetes mellitus type 2: Overview".) INTERPRETING BLO

Blood Glucose Monitoring Definition

Blood glucose monitoring is a method of assessing the concentration of glucose in the blood. Tests are performed rapidly and easily by using a reagent strip (e.g. Glucostix) where a minute drop of capillary blood is obtained from the clients digits (finger or toe), earlobe or heel. On the condition where the patient has all the equipments this test can be performed at home, office, hospitals, clinics and even when travelling. Purpose Blood glucose tests detect blood glucose levels in people with the following conditions: 1. 2. 3. 4. Diabetes Mellitus (Type 1, Type 2) Gestational diabetes Neonatal hypoglycemia Diabetic Coma

During the test, a portable blood glucose meter (e.g. Glucometer or One Touch) is used to give numerical data or measurement of a patients serum glucose level by inserting the blood stained plastic strip. Some meters are installed with memory application helpful in storing the sequence of test results obtained for easy evaluation.

Paraphernalia 1. 2. 3. 4. 5. 6. 7. Reagent strips or test strip Clean Gloves Alcohol pads Lancets or lancing device Portable glucose meter Watch (with second hand) Pen and Logbook for documentation

Procedure 1. Identify the patient by asking the patient to state his/her name. Also check the clients identification band. ( confirm patients identity using two patient identifiers, based on the hospital protocol) 2. Explain the procedure to the patient or parents (if patient is a child) to gain cooperation.

3. Choose the puncture site. For adults and children fingertips and earlobe can be use. For infants, the tip of the great toe or heel can be the site of puncture. 4. Wash hands and don clean gloves. 5. If glucometer is used, load the strip into the device beforehand. 6. Swab alcohol pad to the chosen puncture site. Use sterile/clean gauze to dry it thoroughly. Piecing the skin with a wet skin (alcohol) allows the chemical to pass through the outer layer of the skin thus, causing the procedure more painful and uncomfortable. 7. To collect a blood sample, position the lancet (pricking needle) at the side of the site. To minimize pain and patients anxiety pierce the skin sharply and briefly. This technique also increases blood flow. For better results, some agencies are using a lancing device (mechanical blood-letting device) wherein the lancets are simply loaded in the spring of the equipment. (Its like using a spring-loaded pen, once you click the button the spring releases the lancet and immediately retracts it after piercing the skin). However, be sure to load an unused lancet before using to prevent spread of blood-transmitted diseases.

8. Dont squeeze the puncture site to prevent diluting the sample with fluids from tissues. 9. Cover the entire patch of strip with blood. 10. Place gauze over the punctured area and briefly apply pressure until the bleeding stops. Ask the parents of a child to do this. 11. If using a reagent strip, leave the blood on the strip for 1 minute (60 seconds). And watch the color change on the strip while comparing it to the standardized color chart of the product container. 12. If glucometer is used, simply follow the manufacturers instruction. 13. Apply an adhesive bandage once the bleeding on the puncture site has stopped. 14. Remove gloves and record the resulting glucose level from the digital display for glucometer or from the color of reagent strip to the standardized chart. Common Errors in Blood Glucose Monitoring 1. Dropping a very small amount of blood 2. Inappropriate timing ( the test is usually performed before meals and at bedtime, or whenever hypoglycemia or hyperglycemia occurs) 3. Squeezing the puncture site too hard allowing tissue fluids to mix with the sample

4. Improper maintenance of glucometers (dust or blood accumulation on the digital display)