Article by Lahle Wolfe, 02/24/2006. Ms. Wolfe is a diabetic, as well as the parent of a child diagnosed at age 4 with type 1 diabetes.
Family Doctor; Diabetes: Monitoring your blood glucose
Canadian Diabetes Assn.; How to monitor your blood glucose
dLife.com; Blood glucose monitoring
What are normal and target blood glucose ranges?
Print Blood Glucose
Diabetes Care Tips
Blood Glucose Monitoring
They Work and Meter Features
Alternative Testing Sites
Should I Test My Blood Glucose?
Should I Test My Blood Glucose?
Blood Glucose Monitoring Devices
Do's and Don'ts of Hypoglycemia: Ruggiero, founder of the Hypoglycemia Research Foundation, has written this book
for people who are in the early stages of hypoglycemia and need
introductory-level information. Ruggiero, who has hypoglycemia herself, shares
her own travails of being misdiagnosed several times. She stresses the
importance of obtaining an accurate diagnosis and receiving proper medical
treatment, explains the necessary diagnostic tests, and describes how to find a
doctor. Appendixes include a bibliography, a list of referral organizations, and
recommended foods and menus. This is a very reasonable, well-researched
presentation of a topic which has often been treated faddishly in other
publications. Recommended for public libraries.
Blood Glucose Monitors
Insulin Injection Devices
Symptoms, Causes, Treatment and Prevention of Hypoglycemia
Symptoms, Causes, Treatment and Prevention of Hyperglycemia
FDA Glucose Meter Warnings
Links for More Information and Meter Comparison
Terms to be Familiar With
Alternate Site - Testing anywhere other than your finger tips. Not all meters can accommodate alternate testing. Be sure to read all the instructions that come with your particular meter. Unless a meter is specifically designed for alternative site testing always use fingertips instead.
Blood Glucose - Another term for sugar found in the blood stream.
Hypoglycemia - Low blood glucose. Any reading 70 mm/dL is considered low for diabetes and should be promptly treated.
Hyperglycemia - High blood glucose levels. Depending upon when the reading is taken if your blood glucose is higher than a certain range you may need to correct the high with an insulin bolus.
Glucose Meter - A device used to test blood glucose levels.
Lancet - The needle portion inside a lancing device that pricks the skin to draw blood. Some lancets can be used without a lancing device. These are commonly used in doctor's offices.
Lancing Device - The device that is used to hold the lancet for pricking the finger. Lancing devices have "auto" eject features when you are ready to change the needle and come in various needle widths and lengths.
Test Kit - Used to describe the combination of a glucose meter, lancing device, and test strips. May also include fast acting sugars and glucagon.
Test Strips or Drums - All meters use blood in some way to test and return blood glucose readings. Strips are either inserted into the meter or a drum is inserted into the meter that houses test areas.
Islets of Hope
Always register your lancing device and glucose meters with any warranty or product information card that comes with ALL of your diabetes devices.
Product recalls, warnings and changes in testing site instructions happen a lot in the diabetes product world. Recent product warnings have been released for meters made by Abbot (including their Freestyle meters), as well as for some AccuChek meters. Unless you register your product, or follow diabetes headline news you have no way of knowing about defects and care instructions that are subject to change. During the past year, I have received four important product warnings from meter companies, including an error in instructions as to alternate sight testing and meter malfunctions that resulted in grossly inaccurate glucose readings.
You can also chose to join our "Headlines" e-mail list. Any product warnings that come out publicly will be repeated and sent out to all list members.
main Diabetes Tests page
Diabetes Care Tips
Blood glucose monitoring - Section 1 Print this Article
About Glucose Monitoring and Glucose Meters
Terms to Be Familiar With
Lancet and Lancing Device Tips
"Less-Pain" Finger Sticks
Quick Summary of Glucose Testing Tips
Important Tips for Accuracy
Special Care Tips for Children
On to Section 2
About gucose monitoring and glucose meters
For complete information on meter types, costs, and features see "Glucose Meters."
Blood glucose monitoring is a way of testing how much glucose is in the blood (glycemia). Hypoglycemia means low blood glucose, hyperglycemia refers to high blood glucose, and normoglcyemia indicates normal blood glucose levels. In the United States, blood glucose is measured in mg/dL (milligrams per deciliter). In most other countries, blood glucose is measured in mmol/L.
Blood glucose meters measure how much glucose is in a given blood sample. Where the sample comes from (fingers, toes, forearms, ear lobes) will affect test results. A test strip is placed inside
a blood glucose meter (you can ONLY use test strips designed for your particular meter). A drop of blood is then placed on the strip. Blood reacts with chemicals in the
test strip causing a small electronic pulse to be sent into the meter which then
calculates the level of glucose in the blood sample and shows the result in a digital display.
Lancet and lancing device tips
You do not have to use the lancing device that came with your test kit. As long as the lancing device you are using draws sufficient blood for your meter you can use anyone that you want. Not all lancing devices are equal. Generally, the smaller the drop of blood the less pain involved. If you choose one that does not draw sufficient blood you will have to squeeze (or "milk") you finger for more blood. Most people, children in particular, find the hard squeezing more painful than a larger needle, or slightly deeper setting.
- Depth Setting - Start out on the lowest possible setting. The deeper the needle penetrates the more blood is drawn, but this will also increases pain.
- Changing Lancets - You do not have to change lancets with every finger stick. However, the needle does dull with each use. Duller needles = more pain and you may have to up the depth setting to draw a blood sample. Many people who test 4 or more times per day change out their lancet once or twice a day at breakfast or bedtime.
- Cleaning Your Lancing Device - Your lancet device should be soaked in rubbing alcohol at least once per week or anytime it is exposed to questionable germ sources. If it falls into the toilet (yes, this has happened to me, along with an insulin pump) it is better to just throw it away. You can put most lancing devices (remove the lancet first) in the dishwasher or steam-based toothbrush cleaner to sterilize it. Do not microwave or boil your device; you will ruin it.
- Lancing Device Safety - Be sure that only one person uses any particular lancing device. While blood droplets are tiny, producing less blood than a playground scrape, there is always the concern of disease transmission if more than one person uses a lancet. Be sure to explain to children that they should never prick other people. In 2005 there was a lot of bad PR about the safety of children with diabetes in public schools when a young girl took her diabetic mother's lancing device to school and pricked many of her classmates. The students ended up having to be tested for AIDS. When one of the children that was pricked was found to be HIV positive there was, understandably, a lot of parent anxiety.
IOH Tip: Almost all children (and many adults) fear needles of any sort. If your child is newly diagnosed it will take time to adjust to the many pricks each day. It is helpful if you practice on yourself first. Children may appreciate that you too are going through the same thing and it is a good way to see what hurts and what does not. (See "Less-Pain" Finger Sticks tips below.)
You might also contact your local Juvenile Diabetes Research Foundation Chapter. Many of JDRF's chapters offer free meters, books, and even an adorable stuffed bear (Rufus of Rudy) to comfort children newly diagnosed with diabetes. The bears have hearts on their paws, bums and tummies -- places children have to take shots and finger sticks.
"Less-pain" finger sticks
Once, my 10-year-old (who should know better) called me in a panic with a blood glucose reading over 400 mg/dL. But when she washed her hands, ridding them of the remains of a sugary snack she had eaten earlier, her glucose was normal. Because of the disparity between 400 and normal I did a third check which confirmed her blood glucose was in fact, normal. To have administered insulin to treat a 400 reading would have created a medical emergency. This brings me to my first tip (because repeating sticks causes more pain):
- Make sure fingertips are clean and dry. Although many doctors recommend alcohol pads for convenience they can dry out the fingertips making it harder to draw blood. Also, alcohol, if not totally dry, will prohibit the blood from "beading" so that it can be easily applied to the test strip and may cause stinging. It is better to simply wash hands with warm water and soap. The idea behind hand cleanliness has little to do with being sanitary issues because finger infections from lancets is rare. But foreign substances (food, juice, chemicals, dirt) can pollute the blood sample and provide false readings.
In a pinch I pour bottled water (which I always keep in the van for such purpose) over my child's hands to clean them. Disposable hand wipes and sanitizers can produce false readings. Although many people do use them without complaint, many parents prefer plain water in a pinch over hand sanitizers. Again, the issue has more to do with ensuring nothing on the hands will interfere with, or alter the results of blood glucose testing, rather than a serious concern for infection (I see doctors cringing....)
- Where NOT to stick fingers - Always try to avoid pricking the finger on the pad where the most nerve endings reside. This not only induces unnecessary pain but is also not the best "bleed" site on the finger.
- Prick fingers on the sides, a little bit away from the nail (too close to the nail hurts!). This is where the most blood vessels are and the fewest nerve endings. Smaller fingers bleed better than larger, calloused ones, and the thumb often has the thickest skin. Using all the fingers and thumb are fine, but you may need to adjust the depth setting for fingers with calluses or thicker skin.
- Stopping the blood After A prick - Again, rubbing alcohol serves to both dry out skin and cause stinging and it really is not necessary. Here is where you can use an alcohol-free disposable hand cleaner to clean hands and apply pressure if needed. Sometimes finger sticks continue to bleed, especially on tiny fingers.
I keep small gauze pads in my daughter's test kit, insulin pump pouch, or in my purse to apply pressure for what she calls a "gusher." But Elizabeth much prefers to simply apply pressure herself or (now mom cringes) plunging her finger into her mouth for a second. While this may work, it can be disconcerting to other people, especially to parents and school officials.
Teach your child how to use a dry gauze pad (cut into small pieces) or cotton ball (which I find "shed" fibers that can stick to the skin) to stop bleeding and reassure other folks. Make sure anything with blood gets tucked away discretely or disposed of in a sanitary place like a sharps or biohazardous waste container.
Quick summary of blood sugar (glucose) testing tips
- Make sure hands are clean and dry.
- Have everything ready to go. Prepare meter to receive blood droplet and then perform the finger stick.
- Hold hands down to let blood flow into fingers - keeping hands below heart level.
- You can trying rubbing, massaging, or gently milking fingers prior to finger sticks for better results.
- Running hands under warm water also helps increase blood circulation to the fingers -- just make sure fingers are dry.
- Stick fingers on the sides, not the pads. If using alternative sites pinch or slap the area first.
- Do not immediately attempt to "milk" or apply pressure to increase blood flow as this will actually have the opposite effect of decreasing blood flow. As soon as the body senses the skin has been punctured it seeks to stop the blood flow with clotting factors. Wait just a second before gently milking or squeezing and you will find that the fingertip will produce blood more easily.
- Saturate the test strip area with blood. If you do not, you will get an error message and have to start all over again. Sometimes, if the finger is wet or contaminated you will also get an error message.
- Read the meter and take any corresponding action necessary.
Important tips for accuracy
- Make sure fingertips (or alternate site) are clean and dry.
- Make sure you supply enough blood to the test strip area.
- Make sure the meter is calibrated (some meters do not require calibration) whenever you use a new vial of test strips.
- Make sure your meter settings are correctly set for ml/dL or mol. Whatever setting you use make sure you know which setting the meter is on otherwise you will misinterpret the results.
- If you use alternate sites be aware that this is NOT the most accurate blood glucose reading. The body is dynamic and there is a delay in blood glucose between fingertip and forearm. Forearms are not a reliable test site (nor other areas including toes) which will register blood glucose higher than fingertips. If your alternative site reading is low, repeat on the finger tips. If your alternate site is normal or high but you still feel like you could be low, or have any of the symptoms of low blood glucose, repeat the test on the finger tip!
- Take good care of your meter and test strips. Do not expose them to heat, moisture or direct sunlight. This can damage the equipment and produce false readings. If you ever suspect that your meter is not performing properly throw it away and get a new one!
Always have a backup meter handy, and never, ever go anywhere without a meter, plenty of test strips, lancing supplies, fast-acting sugars, medical identification bracelet and information card for your wallet or purse, and, if you are on insulin, always carry a glucagon kit.
Special care tips for children
Remember that most children are fairly resilient; they will adapt to their diabetes care program probably a lot faster than you will. Letting a child return to normal activities after diagnosis is scary for parents, but crucial for children's mental health. Here are some tips to help ease the transition from "everything's rosy" to dealing with a serious, and chronic illness:
- Children need reassurance from you. Needles are no fun and once diagnosed, will be a fact of life for a child with diabetes. Practice on yourself to see what works best and produces the least amount of discomfort. If nothing else, it may help you better understand what you child has to go through.
- If your child resists glucose checks (or shots) don't yell or fight. This will only increase their tension (and your own) and you will end up chasing your child around the house and having to pin them to the floor to test them. Calmly explain that it needs to be done and when it is over they will get a nice cuddle or story. Offer rewards that are emotionally supportive (like time, hugs, kisses, and tickles) rather than toys, money, or food.
- When your child shows anger or sadness over diabetes and what the care entails, agree with them and validate their feelings. "Yeah, diabetes stinks," goes a long way with children. You can then offer coping skills and positive slants such as reminding them you are in this together.
- Never belittle your child if they say finger sticks or shots hurt -- they can and do. Dismissing your child's anxieties will not help. Instead, ask them for their input as to how to do it better. Apologize, "I'm sorry this hurts. Can you help me by telling me how we can do this to make it more comfortable for you?"
- Children, even as young as age 3 are perfectly capable of performing their own finger sticks and even injections with adult supervision. As soon as they are interested in taking control of glucose checks or shots (Elizabeth has been giving her own boluses via her pump since age 5 -- I double checked that she enter the right amount -- and finger sticks since age 4.)
- Give your child a comfort buddy like a stuffed animal or soft doll. Let them have their own lancing device (without a lancet) and syringe with the needle removed to care for their buddy while you care for your child. Many online stores sell diabetes buddies and even dolls with mini insulin pumps for play. Many local JDRF chapters also give out comfort buddies to children.
If your child, you, or other family members are having trouble dealing with diabetes, seek counseling or therapy from a mental health professional because a chronic illness affects the entire family.
The Children with
Diabetes site has an extensive comparison of meters available in North
America, with links to the individual manufacturers.
Sugar Monitors: What you need to know. Reviews pros and cons of meter
options as well as accuracy issues for any meter.