Blood Glucose Monitoring

If you have diabetes, blood glucose testing is a way of life. Blood glucose meters are small battery-operated devices that make it convenient for people to check their blood sugar levels anywhere. They are also smaller, faster, and require less blood than in the past.
Blood glucose meters require that you prick your finger or alternative site and put a drop of blood on a test strip that is inserted into the meter. Testing regularly allows you to look for patterns to see if your blood glucose is in a safe range. If not, a change in diet, increase exercise, or a visit to your healthcare provider for medication to lower blood sugar and your risk of complications may be needed.
Blood glucose monitoring can also tell you if your blood sugar is too low, a potentially dangerous situation that requires you to eat or drink something with 10-15 grams of carbohydrates.

How to choose your meter
 
You have probably seen many advertisements for blood glucose meters and are wondering which meter is the best one for you. Most meters are accurate in how they measure your glucose but they differ in type and number of features that they offer. The American Diabetes Association provides several tips for finding the blood glucose meter that best fits your needs and lifestyle:

• Insurance — Many health insurance companies will only pay for specific meters or have limitations on cost. Check with your insurance company to see what it will pay for and if they cover the cost of test strips.
• Budget — The cost of blood glucose testing is often a barrier to regular testing. Before buying a meter, check the cost of meter test strips, especially if your insurance does not pay for them. A meter may be the cheapest one on the market, but is not a good deal if the strips cost twice as much.
• Ease of use — Larger meter or small? Small meters are more convenient for carrying, but also require more dexterity to use. Look at the packaging for the test strips; are they easy to open? If you have vision problems, look for a meter with a larger display or voice module. Size of strips may also be a consideration, Are the strips so small that you can't get a good grip on them? You might want to consider a meter that uses cartridges instead of individual strips.
• Blood sample size — Check to see how big a blood sample is needed for blood glucose testing. Blood sample size ranges from 0.3 (amount that would fit on the head of a pin) to 4.0 microliters.
• Check during the night? — Consider a meter that has a backlight.
• Alternate site testing — Many new meters on the market today allow you to use alternate sites such as the palm or forearm for testing.
• Support — Many meter manufacturers include a toll-free number on the back of the meter or packaging that you can call for help. Look for a meter that includes clear instructions that demonstrate the correct way to use the meter.
• Smart meters — Some meters store a certain number of blood glucose results in memory. You can find meters with sophisticated data management systems that track diet and exercise as well as your blood glucose.
• Download blood glucose readings to a computer — Most meters offer the ability to download your blood glucose readings to the computer and email the test results to your doctor. However, not all companies offer software that is compatible with Apple computers. Check out compatibility with the manufacturer before you buy

Know your target range

Your doctor will set your target blood sugar range. For many people who have diabetes, target levels are:

• Fasting at least eight hours (fasting blood sugar level) — between 90 and 130 milligrams per deciliter (mg/dL) or 5 and 7 millimoles per liter (mmol/L)
• Before meals — between 70 and 130 mg/dL (4 and 7 mmol/L)
• One to two hours after meals — lower than 180 mg/dL (10 mmol/L)

Remember that your target blood sugar range may differ, especially if you're pregnant or you develop diabetes complications. Your target blood sugar range may change as you get older, too. Sometimes reaching your target blood sugar range is a challenge. But the closer you get, the better you'll feel.

You may become frustrated or obsessed if you don't have the "right numbers" or feel like a failure if your blood glucose numbers are high. Blood glucose monitoring may seem hard to do at first, but as you learn to use the results to understand your body better and manage your treatment, it will become easier. Here are some general tips:

• There's no "right" or "bad" numbers. Blood glucose testing is a tool to help you track how well your treatment plan is working.
• Strive for consistency. Eat at the same time of day and try to eat the same amount of food. What you eat, how much you eat and at what time you eat all affect your blood glucose level.
• Look for patterns in your blood glucose numbers and think about possible causes for your blood glucose patterns or changes from your usual pattern. No matter how well you're managing your diabetes, your blood glucose readings won't be perfect every time.
• You're the most important member of your health care team. Call your health care provider if problems arise or if there are major changes in your glucose test results, or if you have low blood glucose reactions for reasons you don't understand.

The blood glucose number is a reminder, if used correctly, and will help you take control of your diabetes and not allow your diabetes to take control of you. Monitoring and controlling your blood glucose delays the development of long-term complications.

A normal fasting blood glucose target range for an individual without diabetes is 70-100 milligrams per deciliter (mg/dL) or 3.9-5.6 millimoles per liter (mmol/L). The American Diabetes Association recommends a fasting plasma glucose level of 90-130 mg/dL (5.0-7.2 mmol/L) and after meals less than 180 mg/dL (10 mmol/L). The Mayo Clinic endocrinology department has 3 standardized blood glucose target ranges.
Fasting blood glucose targets:

Standard target	80-120 mg/dL (4.4-6.7 mmol/L)
Modified target	100-140 mg/dL (5.6-7.8 mmol/L)
Pregnancy target	60-100 mg/dL (3.3-5.6 mmol/L)

When to test your blood sugar

How often you test blood sugar levels depends on many factors, including the type of diabetes you have, your individual diabetes treatment plan, and how well your blood sugar is controlled.

• Type 1 diabetes. Your doctor may recommend blood sugar testing at least three times a day — perhaps before and after certain meals, before and after exercise, and before bed. You may need to check your blood sugar level more often if you're ill or you change your daily routine.
• Type 2 diabetes. If you take insulin to manage type 2 diabetes, your doctor may recommend blood sugar testing one to three times a day, depending on the number of insulin doses you take. If you manage type 2 diabetes with other medications or with diet and exercise alone, you may be able to test your blood sugar level less often.

How to test your blood sugar

Blood sugar testing requires a blood sugar monitor. Some monitors are large with easy-to-handle test strips, while others are compact and easier to carry. Some monitors track the time and date of each test, the result and trends over time. If you're unsure which blood sugar monitor is best, ask your doctor or diabetes educator for a recommendation.
To test your blood sugar, follow the instructions that come with your glucose meter. In general, here's how the process works:

1. Before pricking your finger, wash your hands with soap and warm water. Then dry them well.
2. Remove a test strip from the container and replace the cap immediately to prevent damage to the strips.
3. Insert the test strip into the meter.
4. Place the tip of the special needle (lancet) on your finger. Stick the side of your finger, not the tip, so that you won't have sore spots on the part of your finger you use the most.
5. Hold your hand down to encourage a drop of blood to form. When you have a drop of blood, carefully touch the test strip to the blood (avoid touching your skin with the test strip) and wait for a reading.
6. Within a few seconds, the meter will display your blood glucose level on a screen.

Your fingertips contain a lot of nerve endings, so make sure to rotate the sites where you stick your fingers. If you have a newer glucose meter, you'll have the option to test your blood glucose from other sites, such as your forearm or thigh. But check with your doctor or diabetes educator first to find out if alternative site testing is appropriate in your case.

Troubleshooting problems

When used correctly, you can count on your blood sugar monitor to provide accurate readings. If you think something's not right, start with the basics:

• Check the test strips. Throw out damaged or outdated strips.
• Check the monitor. Make sure the monitor is at room temperature, and the strip guide and the test window are clean. Replace the batteries in the monitor, if needed.
• Check the code number on the test strips. Some monitors must be coded to each container of test strips. Be sure the code number in the monitor matches the code number on the container of test strips.
• Check your technique. Wash your hands with soap and water before pricking your finger. Apply a generous drop of blood to the test strip. Don't add more blood to the test strip after the first drop was applied.

If you're still not sure what's wrong, do a quality control test according to the manufacturer's instructions and check the owner's manual for other troubleshooting issues. You can bring the monitor to your next doctor appointment as well.

Recording your results

Each time you perform a blood test, log your results. Record the date, time, test results, medication and dosage, and diet and exercise information in a notebook, record book or journal. Better yet, you may be able to download the information to your computer or transfer the information to a mobile device or an online tracking program. The more complete your records are, the more useful they'll be.
This information helps you see how food, physical activity, medication and other factors affect your blood glucose. As patterns occur, you can begin to understand how your daily activities affect your blood sugar levels. This puts you in a better position to manage your diabetes day by day and even hour by hour.
If your blood sugar readings are consistently higher or lower than your target range — or blood sugar extremes don't respond to adjustments in diet or medication — you may need to revise your treatment plan. In some cases, your doctor may suggest changing your diet or including more physical activity in your daily routine. If that's not effective, you may need to take medication or adjust your medication dosage.

 Diabetes and exercise
Before jumping into a fitness program, get your doctor's OK to exercise — especially if you've been inactive. Discuss with your doctor which activities you're contemplating and the best time to exercise, as well as the potential impact of medications on your blood sugar as you become more active.
For the best health benefits, experts recommend 2.5 hours a week of moderately intense physical activities. Examples include fast walking, lap swimming or bicycling. Be sure to check with your doctor to see if these recommendations are safe for you.
If you're taking insulin or medications that can cause low blood sugar (hypoglycemia), test your blood sugar 30 minutes before exercising and once again immediately before exercising. This will help you determine if your blood sugar level is stable, rising or falling and if it's safe to exercise. Consider these general guidelines relative to your blood sugar level — measured in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L).

• Lower than 100 mg/dL (5.6 mmol/L). Your blood sugar may be too low to exercise safely. Eat a small carbohydrate-containing snack, such as fruit or crackers, before you begin your workout.
• 100 to 250 mg/dL (5.6 to 13.9 mmol/L). You're good to go. For most people, this is a safe pre-exercise blood sugar range.
• 250 mg/dL (13.9 mmol/L) or higher. This is a caution zone. To make sure it's safe to exercise, test your urine for ketones — substances made when your body breaks down fat for energy.  Excess ketones indicate that your body doesn't have enough insulin to control your blood sugar. If you exercise when you have a high level of ketones, you risk ketoacidosis — a serious complication of diabetes that needs immediate treatment. Instead, wait to exercise until your urine ketones test kit indicates a low level of ketones in your urine.
• 300 mg/dL (16.7 mmol/L) or higher. Your blood sugar may be too high to exercise safely, putting you at risk of ketoacidosis. Postpone your workout until your blood sugar drops to a safe pre-exercise range. 

During exercise: Watch for symptoms of low blood sugar

During exercise, low blood sugar is sometimes a concern. If you're planning a long workout, check your blood sugar every 30 minutes during exercise — especially if you're trying a new activity or increasing the intensity or duration of your workout.
This may be difficult if you're participating in outdoor activities or sports. However, this precaution is necessary until you know how your blood sugar responds to changes in your exercise habits.
Stop exercising if:

• Your blood sugar is 70 mg/dL (3.9 mmol/L) or lower
• You feel shaky, nervous or confused

Eat or drink something to raise your blood sugar level, such as:

• Two to five glucose tablets
• 1/2 cup (118 milliliters) of fruit juice
• 1/2 cup (118 milliliters) of regular (not diet) soda
• Five or six pieces of hard candy

Recheck your blood sugar 15 minutes later. If it's still too low, have another serving and test again 15 minutes later. Repeat as needed until your blood sugar reaches at least 70 mg/dL (3.9 mmol/L). If you haven't finished your workout, continue once your blood sugar returns to a safe range.

After exercise: Check your blood sugar again

After exercise, check your blood sugar right away and then several times during the next few hours. Exercise draws on reserve sugar stored in your muscles and liver. As your body rebuilds these stores, it takes sugar from your blood. And the more strenuous your workout, the longer your blood sugar will be affected. Low blood sugar is possible even hours after exercise.
If you do have low blood sugar after exercise, eat a small carbohydrate-containing snack, such as fruit or crackers, or drink a small glass of fruit juice.

 Where/which meter to buy


You can buy blood glucose monitoring meters in most pharmacies, medical centers and hospitals.  Links for popular brands in Malaysia you can check out are :

Lifescan(Malaysia) selling OneTouch meters
Roche diagnostics (M) selling Accuchek meters 
Abbott Malaysia selling Optium meters