ABOUT THIS PRESENTATION For Instructor Use Only Target Audience: Patients with diabetes and their families Time Required: 20-30 minutes Suggested Group size: 1 to 20 participants Setting: Clinic, home or bedside Timing: As a part of group or individual DSME Objective(s): Patients with diabetes will learn how to test their blood sugar with a blood glucose meter Handouts & Teaching Tools: None. Can print from slides if desired Equipment Required: Computer to show presentation and multimedia equipment Topics Covered: Preparation for test Meter coding Lancing device setup Obtaining blood sample Alternative site testing Recording results Sharps disposal Testing frequency Blood sugar targets

TEST YOUR BLOOD SUGAR HOW TO … This presentation will teach you the basics of blood sugar testing with a glucose meter, a key step in taking care of yourself when you have diabetes. TEST YOUR BLOOD SUGAR

OVERVIEW Preparing Coding Fingerstick sampling Results recording Sharps disposal Testing frequency Blood sugar targets Here is an overview of what will be covered in this session.

STEP 1: Gather Supplies Gather your equipment You will need: Glucose meter Test strips Lancing device Lancet Logbook & pen/pencil The first step is preparation for testing. Gather these supplies. Most supplies come with the meter. If not, ask your healthcare provider about where to obtain the needed testing supplies.

STEP 2: Clean Hands Wash your hands with warm water and soap It is not necessary to use alcohol to clean skin Then prepare your skin by washing hands with warm, soapy water. Rinse and dry well. It is not necessary to use an alcohol pad. Wet alcohol can actually skew the blood glucose results and repeated use of alcohol will dry the skin.

STEP 3: Prepare Lancing Device Ensure appropriate puncture depth is set Remove top cover and insert lancet Remove top of lancet to expose needle Replace top cover of lancing device Be sure device is “cocked” or “primed” Get the lancet device ready by first loading the lancet. Expose the needle by removing the cap. Replace the lancing device cover and you are ready to go. Cock or prime the device according to the manufacturer’s directions.

STEP 4: Turn on Meter Be sure meter is coded properly- if needed Insert strip into meter The next step is coding. Some meters may require “coding.” This ensures that the meter and strip are matched. Follow the directions that come with the meter if this is needed. Otherwise, place the strip into the meter to turn it on.

STEP 5: Obtain & Apply Sample Lance the side of your finger Apply blood to strip Apply pressure to finger to stop bleeding Now you are ready to perform the fingerstick. Press the lancing device against the side of your finger and press the button. You should feel a poke. To collect the blood sample, hold the drop of blood next to the strip and the blood should load itself. Hold a gauze or tissue on your finger to stop any bleeding when you are done.

ALTERNATE SITE TESTING May use arm or heel of hand to obtain sample Instructions and special device in box Do not use alternate site if: Glucose changing rapidly Suspect hypoglycemia Pregnant You may want to know how to obtain a blood sample from your arm or the heel of the hand. This may not hurt as much, but does require a special cap and further instruction (this comes with the meter). There are times when you should only test at the finger, as above.

STEP 6: Record Results Record results in logbook Will help you see patterns Will help you know what effects your blood sugar May prompt you to call provider if needed Take meter and logbook with you to provider visit each time you go. Record results in logbook Why record? Will help you see patterns Will help you know what effects your blood sugar May prompt you to call provider if needed Take meter and logbook with you to provider visit each time you go.

STEP 6: Dispose of Materials Remove strip from meter and dispose in trash Remove lancet and dispose in hard plastic container Check with your state about disposal http://www.safeneedledisposal.org Record results in logbook

WHEN TO TEST Check with your provider Different patients have different testing needs Possible testing times might include… before meals at bedtime Before taking insulin Before driving a vehicle During the night (especially with insulin changes) Your doctor or medical provider may have told you when you should test your blood sugar. Ask if you do not know.

80-130mg/dl <180mg/dl At least 100mg/dl ARE YOU ON TARGET? Fasting 2 hours after meals At least 100mg/dl At bedtime For most patients, these are the targets to aim for when you are fasting, after eating, or at bedtime. Again, your medical provider may individualize your targets. Ask if you are uncertain.

TIPS TO REMEMBER Use test strips only once Keep supplies at room temperature Keep strips in container with lid on – do not expose to air/heat/humidity/light Do not share your meter with anyone BRING YOUR METER TO EACH VISIT WITH YOUR PROVIDER Remember, don’t reuse a strip. Keep supplies at room temperature. Don’t expose the strips to heat, light, or humidity for long periods. Don’t share your meter. Bring it with you to every medical appointment. These tips will help you and your provider make the most of your blood glucose testing efforts.

SUMMARY Testing your blood sugar is important to achieving and maintaining control of your diabetes. Specific information about a particular meter can be obtained by reading the manufacturer instructions (see next slide). Find out how often you should test and what blood sugar level you should strive for from your healthcare provider.

REFERENCES American Diabetes Association. (2015). Standards of Medical Care in Diabetes—2015 Abridged for Primary Care Providers. Clinical Diabetes : A Publication of the American Diabetes Association, 33(2), 97–111. http://doi.org/10.2337/diaclin.33.2.97 Precision Xtra Manufacturer's Instructions: http://www.abbottdiabetescare.com/static/cms_workspace/document/ART06986-Rev-B.pdf Accu-Chek Aviva Manufacturer’s Instructions: https://www.accu-chek.com/us/glucose-meters/aviva-how-to-use.html Bayer Contour Manufacturer’s Instructions: http://www.northcoastmed.com/pdf/manuals/contour_userguide.pdf