TARGET BLOOD GLUCOSE and A1C LEVELS FOR ADULTS and ADOLESCENTS -- Normal Range Target Goals A1C 4 - 6% Less than 7% Fasting or Before Meal 4.0 - 6.0 mmol/L 4.0-7.0 mmol/L 2 hour after meal glucose 5.0 - 8.0 mmol/L 5.0 - 10.0 mmol/L * Normal range should be considered if it can be achieved safely. * Blood Glucose goals should be tailored to individual needs.

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Self Blood Glucose Monitoring

What is Blood Glucose Monitoring?

People with diabetes can measure their own blood glucose level by pricking their finger (or alternate site) and placing a small drop of blood on a test strip inserted in a monitor. This monitor reads the level of glucose in the blood. Using a blood glucose monitor at home can be valuable in helping you understand and manage your diabetes. Monitors today are very convenient and easy to use.

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Who Should Monitor Blood Glucose?

Anyone living with diabetes can benefit from blood glucose testing. It is essential for all people with Type 1 diabetes, all women with gestational diabetes and women with diabetes who become pregnant. Self blood glucose monitoring is necessary for achieving the best control of your diabetes. Self-testing teaches you how diabetes affects your body's reaction to daily events. Monitoring the level of glucose in your blood can help you make decisions about eating, exercising and taking your diabetes medication.

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Why Monitor Blood Glucose?

To find out the following:

• Do your blood glucose levels fall into your goal range? Over time high blood glucose levels cause damage to the heart, kidneys, eyes, blood vessels, and nerves. If you are pregnant high blood glucose levels can cause problems for you and your baby.
• Are you experiencing a low blood glucose?
• Is your current treatment plan working?
• Are your medications appropriate?
• Are other medications affecting your blood glucose levels?
• How does a typical meal affect your blood glucose?
• How do special meals affect your blood glucose?
• How does exercise affect your blood glucose?
• How does stress or illness affect your blood glucose?
• Is there a pattern of high or low blood glucose at certain times of the day?
• What is your blood glucose level before a meal? If you use meal-time insulin, you can use these results to determine how much insulin to take.

Your blood glucose testing results will help you, your doctor and diabetes educators make the necessary changes in medication, meal planning or exercise to achieve your target blood glucose levels.

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How To Do a Blood Glucose Test

1. With clean hands assemble all tools – monitor, strips, lancing device, lancet, tissue.
2. Get the lancing device ready ie: put in a new lancet, recap the device and set the spring.
3. Get a test strip from the container; be sure to replace the lid. Do not leave strips out of the container. (Note: some models do not require this step)
4. Turn monitor on by inserting strip or pressing button. (Note: this depends on model you use)
5. Prick side of fingertip or alternate site . Be sure to apply enough blood to the correct spot on the strip.
6. Use the tissue to stop the bleeding from your finger.
7. Wait for result.
8. Record result in log book.
9. Dispose of used strip and used lancet in a puncture proof container.

Note: If you should do a blood glucose test on someone else, you must be sure to use a new lancet and end-cap on the lancing device. So you do not get exposed to another person's body fluids.

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When To Monitor

In order to control diabetes well, you need to control the blood glucose 24 hours a day. Checking your blood glucose at different times of the day will give you a good picture of your overall diabetes control. A fasting blood glucose only tells you what your blood glucose is at that time of day with no information of what happens after you eat. People can have a pretty normal fasting blood glucose but still have a high post meal level.

The more you test, the more you will know about your blood glucose levels. Daily events like eating, exercising, taking medications, illness and stress, will all affect your blood glucose. It is important to test your blood glucose levels at different times of the day to help you decide how to manage your diabetes.

There is no gold standard of how often to test, but research tells us that people on insulin should test at least 3 times a day. People on diabetes pills or diet and exercise alone should test at least once a day. It is suggested to do extra tests when:

• you are first diagnosed with diabetes.
• your blood glucose levels are not within the goal range
• you are ill
• you think your blood glucose may be too low or too high.
• you change or start a new medication.
• there are changes in your activity, eating habits, or your weight.

Testing at different times of the day is recommended. Meaningful times to test are:

• before any meal.
• 2 hours after meals.
• Before bedtime
• Around 3:00 am if you take insulin.

	Blood Glucose Record
	( PDF: 64.5 KB / 1 pages)

Your fasting blood glucose (no food for at least 8 hours overnight) is your starting point for the day. Testing before meals helps you assess your diabetes control at that time of the day. Testing after meals gives you a good indication of how well your body is responding to what you ate for the meal. If you are out of your goal range at any time of the day you need to adjust diet, or medications or activity level.

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Keeping Records and What to do with the Results

Keeping an accurate record of your blood glucose results is important. By recording your results patterns can be noted. These patterns indicate where changes in your treatment may be needed.

1. If your blood glucose is higher than your goal range ask yourself:

• Did you have more food than you needed?
• Did you skip your exercise?
• Did you forget your medication?
• Do you need more medication?
• Are you ill or under stress?

2. If your blood glucose is lower than your goal range ask yourself:

• Did you skip a meal or eat less than usual?
• Did you have extra exercise?
• Did you take too much medication?
• Are you ill?

If your blood glucose is often outside of your goal range, it is always a good idea to discuss your treatment plan with your doctor or diabetes education team.

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Pointers for Accurate Results

• When you get a meter you will be instructed on how to operate it. If you are unclear on how to use it, be sure to contact your diabetes educator for help.
• Keep your monitor clean, dry, and away from extremes in temperature.
• Wash your hands in warm soapy water. Dry them well before testing. Cleaning with alcohol swabs is not necessary if you wash your hands.
• Get enough of a blood drop to apply to the test strip.
• If you have difficulty getting enough blood try:
  • Holding you hand in warm water
  • Put your hand down by your side and give it a shake.
• Make sure the code numbers on the test strip container match the numbers on you monitor. You may need to change the code number when you purchase a new container of strips.
• Use the check strip or control solution that comes with your monitor to check its accuracy.
• The next time you go to the lab for a blood glucose test take your monitor and do your own test to compare your monitor’s result to the lab result.
• Make sure your strips are not outdated.

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Blood Glucose Testing Supplies

1. blood glucose monitor
2. test strips
3. lancing device and lancets
4. tissues
5. control solution and or check strips (usually come with the monitor)
6. log book or sheets
7. sharps container

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Alternate Site Testing

If you no longer want to test your blood glucose because your fingers hurt you may want to try getting blood from another site with fewer nerve endings. This is called alternate site testing. The most common area for alternate site testing is the forearm.

Certain monitors have been approved to do alternate site testing. Only these designated monitors can be used for this purpose.

Before you consider alternate site testing consider these important facts.

- Under certain conditions, there is a difference between the circulation of blood to the fingertips and the top of the forearm.

- When blood glucose is changing quickly, fingertip blood is a more accurate reflection of the glucose level in the body. Samples of blood from the forearm are slower to show these changes.

- Times when rapid changes in blood glucose level are likely to occur are:

1. After a meal
2. After an insulin dose
3. During or after exercise.

   These are times when fingertip testing is advised.

Alternate site testing is used prior to, or more than two hours after:

1. Meals
2. Insulin dose
3. Exercise

Use fingertip testing if you suspect hypoglycemia. Forearm testing may fail to show a low blood glucose.

Blood Glucose Extremes

Hyperglycemia

High Blood Glucose

• Going to the bathroom often
• Thirsty
• Feeling tired all the time
• Hunger
• Weight loss
• Blurred vision
• Dry, itchy skin
• Slow healing wounds
• Irritability
• Nausea, upset stomach
• Fruity smell to the breath
  

When you have hyperglycemia frequently or for long periods of time, damage to eyes, kidneys, heart, nerves, blood vessels, can occur. More on complications.

More immediate complications of extremely high blood glucose levels are:

1. diabetic ketoacidosis (DKA)
2. hyperosmolar hyperglycemic nonketotic syndrome (HHNS)
   

Causes of hyperglycemia are:

• Eating too much carbohydrate
• Too little insulin or diabetes pills
• Forgetting or skipping your diabetes pills or insulin.
• Less physical activity
• Physical stress such as illness (infection, surgery, flu etc.)
• Emotional stress
• Taking other medications that interfere with blood glucose control. (eg. Cortisone)

What should you do after you have been diagnosed with diabetes and you suspect your glucose level is high again?

1. Test your blood glucose level.
2. If your blood glucose is higher than 15.0 mmol/L – people with Type 1 diabetes need to check for the presence of ketones.
3. Drink a lot of water. This helps to avoid dehydration.
4. Try to find the cause of the hyperglycemia.
   • Has your eating pattern changed?
• Have you been less active?
• Is there added stress in your life right now?
• Are you ill?
• Did you remember your medication and take the correct amount?
5. Try to correct the cause of the high blood glucose
6. Call your doctor or diabetes educator if you are not able to bring your blood glucose down or if your ketones are elevated.

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Hypoglycemia

Low Blood Glucose

Hypoglycemia is a fall in the blood glucose level below the normal range. A blood glucose level of less than 4.0 mmol/L is usually considered too low. (Different levels apply to children with diabetes).

If you take insulin or certain types of pills for diabetes, you are at risk for hypoglycemia.

Hypoglycemia occurs when there is too much insulin and not enough glucose in your blood. Causes of this are

1. Taking too much insulin or diabetes medication.
2. Missing or delaying a meal.
3. Eating less.
4. Exercising more strenuously or longer than usual.
5. The effects of drinking alcohol.

Hypoglycemia may also be called “insulin reaction” or “low blood sugar”. This drop in blood glucose can happen very quickly therefore, it is important to recognize the symptoms of hypoglycemia so you can take care of it right away.

Signs of Hypoglycemia are:

• Feeling shaky or lightheaded
• Sweating
• Feeling hungry
• Feeling nervous or irritable
• Feeling weak
• Your heart beats faster
• Feeling confused
• Blurred vision
  

How do you treat hypoglycemia?

Eat or drink 15 grams of carbohydrate, such as:

• 3 large or 5 small glucose tablets
• ¾ cup of juice or regular pop
• 3 teaspoons of sugar, honey or syrup
• 6-8 lifesavers

Wait 15 minutes and retest your blood glucose. If it is still low - treat again with the same amount of carbohydrate.

If it is more than one hour until your next meal or snack, you need to eat some extra food that contains carbohydrate.

Prevention is the best way to manage low blood glucose. Avoid imbalances between food, diabetes medication and exercise. Remember:

• Maintain good blood glucose control
• Recognize symptoms of low blood glucose
• Eat on time, eat enough, and do not skip meals.
• Take your medication as prescribed
• When increasing activity or exercise, you may need to decrease your insulin prior to the activity or increase food intake and test more often.

Always carry an immediate source of “ready” sugar with you and carry identification that states you have diabetes.

If you take insulin or pills for diabetes, discuss with your family, friends and co-workers the signs and symptoms of hypoglycemia and how to treat a low blood glucose.

Some people with diabetes want to make a hypoglycemic episode pleasant for themselves by treating their hypoglycemia with a favorite food such as ice cream or chocolate bar. These types of food are high in carbohydrate but also in fat. Their fat content delays their absorption, thus delaying treatment of the low blood glucose.

Low blood glucose in an unconscious person warrants treatment by glucagon injection.

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Glucagon (Glucagon Kit)

• Glucagon converts a “stored form of sugar” that’s in your liver to glucose, which can then be used by your body.
• This medication is injected into a person with severe hypoglycemia, when he/she is unresponsive and unable to swallow.
• Parents, spouses, teachers, friends, etc. should be educated regarding procedures of when and how to use glucagon.
• A physician order is needed to obtain glucagon from the drug store.
• Glucagon does have an expiry date and will need to be replaced when outdated.
• The use of glucagon should be discussed with the individual with diabetes and the diabetes health care team.

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Diabetic Ketoacidosis (DKA)

It is a dangerous short-term complication of diabetes caused by lack of insulin, which results in high glucose levels and ketones in the blood. DKA is a medical emergency.

DKA occurs mostly in people with Type 1 diabetes. It is usually present at the time of diagnosis, but may occur when blood glucose levels are out of control. It may also be caused by an increased need for insulin (e.g. when you are ill or under a lot of stress).

If your blood glucose and ketones are high, and you have these symptoms seek medical attention.

Symptoms:

• nausea and vomiting
• rapid breathing
• fruity smell to breath
• extremely tired or drowsy
• weakness

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Ketones

Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)

This serious condition occurs when the blood glucose gets extremely high, causing dehydration. HHNS can be present at the time of Type 2 diabetes diagnosis, or when someone with Type 2 diabetes has:

1. An illness
2. A lot of stress
3. A low fluid intake (eg. A frail elderly person living alone)

Symptoms of HHNS are:

• Increased thirst
• Blurred vision
• Frequent urination
• Weakness
• Drowsiness
• Headache
• Restlessness
• Confusion
• Flu like symptoms or just not feeling well.

You may be hospitalized if HHNS is not noticed in the early stages. Treatment of HHNS requires fluids as ordered by your doctor and may require insulin. If left untreated, it could lead to coma and death.

To prevent HHNS check blood glucose levels regularly and take action to get the blood glucose levels under control.

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