Monitoring Diabetes

What is Monitoring? Finger-stick blood sugar testing Like a “snapshot” A record of finger-sticks shows a trend Trends show what needs to be changed Hemoglobin A1c is like a summary of 2-3 months of finger-stick readings

“Snapshot” vs. “Summary” Example: Finger sticks average 200 : A1c will be about 8% Finger sticks average 150: A1c will be about 6.4% Non-diabetic finger sticks 100-125; A1c is between 4.6-5.4%

Why Check Blood Sugar? To help make good food choices To know how exercise or illness affect blood sugar To help you know if your blood sugar is too high or too low To help understand symptoms

Monitoring Goals Fasting: 70-130 Two hours after a meal: less than 180 Before a meal: about 100 (70-130) Bedtime: 100-120 (snack if less than 100) 2:00-3:00 a.m.: 100-120 Hemoglobin A1c: 6%-7%

Putting finger sticks to work! Did I eat too many carbs at a meal? Check FSBS 2 hrs after meal More than 180…YES, too many carbs! I am feeling “funny.” Is my blood sugar too low or too high? Check FSBS: Less than 70, drink ½ cup juice or non-diet soda; If 500-600, go to hospital!

Putting finger sticks to work! Is my liver making too much sugar at night? Check FSBS at 3:00 a.m. several times a week and tell provider results Is exercise really making a difference? Check FSBS before and after exercise

When to Test Blood Sugar No one set time Test at different times of day Test more often if sick General testing times: Before breakfast (no food for 8 hours) 2 hours after each meal Before a meal At bedtime At 3:00 a.m. occasionally

FSBS Record 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Fasting (before breakfast) 2 hrs after breakfast 2 hrs after lunch 2 hrs after supper 3:00 A.M.

What if… My fasting and bedtime finger sticks are at goal, but my A1c is too high? What is happening after meals? When was the last time A1c was checked? How old is the meter? Are the strips expired? Let’s brainstorm here… What might be some reasons why fasting and bedtime FSBS are at goal (100-130) but A1C is say at 8% (meaning average blood sugar is about 200)? What is happening after meals? Check 2 hrs after meals to see if the blood sugar is rising too high Is the meter working properly? If meter is >2 yrs old, it is time to replace it! Check expiration dates on strips. If using insulin, what injection sites are you using? Fastest from the abdomen (stomach) A little slower from the arms Even slower from the legs Slowest from the buttocks Rotate sites, but use the same general area each day for injections given at a specific time of day. Ex: at night, always give your long-acting insulin in the thigh. If you are getting ready to exercise, do not inject insulin in a muscle that you will be working out.

Let’s Review! True or false: fasting blood sugar should be about 160. Give 3 reasons why checking blood sugar is important. True or false: If you are not taking insulin, you do not really need to check your blood sugar. When should you check your blood sugar?

How to Test Blood Sugar Keep all supplies in safe place with log book and pen Make testing part of your routine Get a good drop of blood Wash hands Dangle fingers below waist Gently squeeze finger until it is red Prick the sides, not the middle Thumbs and pinkies have better blood supply

More Tips Try to always use sides of fingertips Warm your hands first if it is cold Don’t share equipment with others Calibrate (set up) your meter with each new box of test strips Make sure the test strips are not expired

Things that affect reading A dirty meter Meter/strips that are too cold or too hot An outdated test strip An outdated battery in meter A drop of blood that is too small Touching the strip on the electronic section Not getting “sipping” action of blood into strip; need a “hanging drop”

Let’s Review! Which fingers have a better blood supply? How often do you need to calibrate or set up your meter? Which part of the test strip should not be touched: the part where you place the blood sample or the electronic part?

Bring your meter and log book to every appointment!