Page 23 - The SA Journal Diabetes & Vascular Disease Volume 9 No 4 (November 2012)

VOLUME 9 NUMBER 4 • NOVEMBER 2012 165
SA JOURNAL OF DIABETES & VASCULAR DISEASE MONITORING
ward trends in blood sugar, allowing health professionals or individuals to
pick up problems without waiting for an HbA 1c.
For self-monitoring of blood glucose to be successful it must be part of
a wider education process for the individual patient, empowering them to
make changes to their treatment independently of the healthcare profes-
sional.
Patients need to understand why they are monitoring their blood glucose
levels, and what they are hoping to achieve from testing. This includes know-
ing their individual target levels, both pre- and post-prandial, and what to do
when results are outside these ranges.
There are generally accepted values for good glycaemic control. A
blood glucose level less than 4 mmol/l is classed as hypoglycaemic,
whether it produces symptoms or not. Levels of fasting blood sugar and
before meals should be 4–7 mmol/l and, for two hours post-prandial,
blood glucose should be < 9 mmol/l.
To facilitate effective review by a healthcare professional, blood glucose
results should be recorded. The most convenient format is in a diary-type
of record book. This allows results at the same times on different days to
be compared, and variations at weekends to be seen. Some people rely
on their blood glucose meter’s memory facility, but this is only useful if
the date and time are correct. And it does not allow for notes to be made
about results.
Other people prefer to download their readings to a computer, with
some producing graphs. However, the results recorded will only aid gly-
caemic control if the patient looks at them and acts on them. Allow time
during the annual review to go over monitoring. It is all too easy to over-
look it because few computer templates contain prompts or allow space
to record that monitoring has been discussed.
METERS
Blood glucose meters are not available on the NHS. They are usually
provided by manufacturers or patients purchase them for their own use.
There should be a meter to suit every individual from the wide range
available. A guide, such as MIMS for Nurses, can be helpful in making
comparisons.
Options include:
Self-/non-calibrating meter •
Large screen/large buttons •
All-in-one meter, strips and lancer •
Backlit screen •
Computer downloadable results •
Pen-size meter •
‘ Talking’ meter. •
Results vary from taking 5–15 seconds. The amount of blood sample re-
quired for testing also varies. Ideally, a person should be able to compare
several different meters before choosing the one that suits him or her.
Healthcare professionals should keep themselves up to date on meters to
ensure they can provide information to meet every patient’s needs.
All meters should be preset to measure glucose concentrations in
mmol/l in the UK. There have been serious incidents where meters have
been preset or accidentally changed to measure glucose in mg/dl, the
units used in the US. Test results in mmol/l will always contain a decimal
point, while those in mg/dl never have a decimal point.
Meters should be kept clean from blood and dirt. They need to be kept
at room temperature and, if taken out of the patient’s house, will need a
period of time to readjust before a test is performed. Patients should be
advised to be particularly careful if meters are kept in their car for check-
ing glucose before driving, because they may have become very hot if
stored in a glove compartment or boot. They need to be kept out of direct
sunlight and out of extreme heat or cold. Results should be treated with
suspicion if the meter has been exposed to temperatures above 40°C.
A diabetes review clinic should include assessment of:
• Self-monitoring skills
• The quality and frequency of testing
• How the results are used
• The impact on quality of life
• The continued benefit
• The equipment used.