Blood glucose testing

Testing is probably the most important weapon in your armory to take control of your diabetes. “Jennifer’s Advice” is an excellent and much recommended guide to the whys, wherefores and whens to test, with very sensible advice on how to decide which foods are good for you and which you should avoid. The NHS dietitians have a “one size fits all” diet that they hand out to diabetics. Unfortunately we are not all alike, and what we can tolerate in the way of foodstuffs varies accordingly. Therefore, ascertaining what works for you as an individual is paramount in gaining control. We would recommend you read “Jennifer’s Advice” in addition to the “frequently asked questions” regarding testing which are laid out below.

Why do I need to test my blood sugar?

glucometerMonitoring your blood sugar (also called glucose) level can help you take better care of your diabetes. Checking your blood sugar will help you learn how food, activity levels, stress, medicine and insulin change your blood sugar level. This information will help you stay healthy and prevent or delay diabetic complications such as blindness and kidney failure. The goal is to reach a sugar level closest to the non-diabetic range as safely as possible. Testing is essential because the blood sugar level cannot be accurately determined by symptoms alone.

For most people attempting to achieve good control, four or more tests a day are usually required. Readings should always be recorded, as well as the food or carbs eaten and medications or insulin doses taken. This information received can then be used to adjust insulin doses, medications, meal planning, and exercise to greatly improve blood sugar levels. Although testing can clarify unclear symptoms, the major reason to test is to improve your blood sugar results, and to maintain excellent results once control targets are achieved.

Monitoring your blood sugar level will not produce better results. Interpreting the monitored levels, and acting appropriately is what will!

When should I test?

The frequency and timing of tests will vary depending on an individual’s therapy, goals, and resources. When any changes occur in food, exercise, medications, illness, or travel, more testing should occur.

  • Type 1: Upon waking (fasting), before meals and bedtime, 1-2 hours after meals and during night as needed.
  • Type 2: Upon waking (fasting), before meals and/or bedtime, 1-2 hours after meals as needed.

What equipment do I need to test my blood sugars?

You will need a blood glucose meter and some test strips. Most meters come with a lancet for pricking your finger and a starter supply of strips. There are many kinds of BG meter on the market and which you choose is a matter of personal preference. Some meters have cables and software available so that you can download your results onto the computer. Some meters come with individual foil wrapped strips. The most modern meters require the smallest drop of blood and have a test time of 5 seconds or less. The choice is ultimately yours. Check out the manufacturer’s websites below for all the features of the available meters.

How do I get a blood glucose meter?

Quite often the representatives from the meter manufacturers will supply your GP’s surgery with free sample meters and the practice nurse or GP will give you one. If they do not, then you may get a free meter from the manufacturer themselves. Check our links page and the forum for any offers that we know about. Alternatively you can buy a meter in almost any chemist or branch of Boots for a few pounds. Some of the larger supermarkets who have pharmacies often offer meters for £3 – £4. The reason the manufacturers give meters away or sell them quite cheaply is because they do not make their money on the meters, they make it on the test strips which are relatively expensive. 50 test strips will cost between £23 – £27 to buy over the counter. They will cost the NHS £13 – £16

How do I test?

Ensure you have the meter properly set up and calibrated for the batch of test strips you are using (most meters require you to calibrate with a special strip every time you open a new batch of test strips). Read the manual which will have come with your meter. Wash your hands in warm water and dry thoroughly. The reason for this is twofold. Firstly to remove any substances (such as foodstuffs) from your fingers which may give a false reading. Secondly the warm water will improve the blood flow and enable you to get a drop of blood more easily. Insert the test strip into the meter as recommended by the manufacturer. Ensure your lancing device is set to a level which is comfortable for you and will produce a drop of blood. Most lancing devices have a number of settings, 1 being the shallowest and 5 being the deepest. If you are unsure, start at level 1 and work up until you have a comfortable level. Place the lancing device firmly against the side of the tip of your finger and activate it. If you do not get a drop of blood sufficiently large enough for your meter, hold your hand downwards and with the thumb and forefinger of your other hand “stroke” the pricked finger firmly downwards several times, starting at the base of the finger, in a “milking” motion. Some people find that holding their hands down by their sides and shaking the hands prior to lancing is beneficial in improving blood flow. When you think you have a sufficient drop of blood, apply it to the test strip. Most meters will allow a few seconds to apply a second drop of blood if the first is insufficient. Depending on the time required, your meter should show a result within a few seconds. Rotate the test sites, using all your fingers and each side of each finger so that the ends of your fingers do not get too sore

What levels of blood sugar should I be aiming for?

Ideally:

  • Fasting Under 6
  • One hour after meals Under 8
  • Two hours after meals Under 6.5

I’ve just tested and the result is much higher than I anticipated, what can I do?

Is there any chance that you could have some contamination on the finger you used for the test? Many a diabetic has had a shock like this, only to discover they had a smear of honey, jam or some other foodstuff on their finger. Wash your hands and test again if this could be the case. If the figure is genuinely high a little exercise can help immensely. Even a brisk walk around the block will bring your BG down. Make a note of the high reading and think back to what you ate and make a note of that. Either eliminate that food from your diet or adjust the quantity you have next time. Learn from the experience.

If you are a Type 1 and your BG result is over 14 mmol, test for ketones. Your doctor should have prescribed Ketostix with which to test your urine and explained the procedure to you. If ketones are present, consult NHS direct or your DSN for advice as to what to do. Type 2s are unlikely to present ketones.

My doctor will not prescribe test strips. He says as a T2 I do not need to test.

With all due respect to your doctor, he does not have diabetes, you do and you are the one who will have to suffer any complications. As mentioned earlier on this page, the manufacturers make their money on the test strips which are expensive. The primary care trust in charge of your region sets the budgets for the doctors and some (not all) PCTs have advised doctors that it is against their policy to issue test strips to T2 diabetics. This is purely a budgetary issue. Of course, a secondary reason that doctors may be reluctant to prescribe strips is that without the education to do anything about the results of their testing, many diabetics become discouraged and depressed. You are here looking at this website and hopefully joining in this forum to gain the education that will empower you to control your diabetes and to do that you must be at least 60% of your own diabetic team. Which means knowing what your BGs are and why, using the results of your testing to adjust your lifestyle. So try to persuade the doctor that, at least to begin with, until you have a good idea of what diet suits you, you need the strips. Promise to keep records of the testing and explain to him how you intend to use the results.

My doctor still refuses to prescribe strips, is there anything else I can do to persuade him?

In May 2007 one of the founders of this site petitioned No. 10 Downing Street regarding the restriction of test strips to T2 diabetics. The government’s response clearly stated that this was not government policy and said “Any PCT which is automatically discouraging the prescription of blood glucose testing strips is not acting in accordance with NICE’s advice that self-monitoring may prove useful to people in their overall approach to self-care.” Print out the “Response to the petition to No 10 regarding limiting test strips to T2 diabetics” and take it along to your doctor.  Here is a letter from Diabetes UK that you can address to your Dr and print out to give to him Restriction of blood glucose test strips – letter to GP A leaflet has been produced by the NHS which addresses the issue of self monitoring of blood glucose and supports it in individuals where there is a clear purpose and where it motivates patients to maximise the effects of lifestyle and diet.  We suggest you download and print out this leaflet to take to your doctor.  It may also be advisable to print out Jennifer’s advice to show how you are going to use the strips to maximise control.

If all else fails, write to your MP!

I want to start testing right away, but it’s going to take me some time to persuade the doctor. Is there any way I can get some test strips meanwhile?

You can of course buy the strips over the counter at the chemist. You may have some frustrating conversation with them first, but they can sell them to you. In addition, as you are diabetic you can get the VAT deducted. Although the High St chemists are not always set up for this transaction you will find that a lot of on-line pharmacies are, and they may be cheaper. It pays to shop around.

My doctor will prescribe strips, do I have to pay the prescription charge?

If you are T2 on diet and exercise only, you will have to pay for the test strips like any other prescription. If you are diabetic and are on medication or insulin then all your prescriptions are free, whether diabetes related or not. You will need to get a Prescription Exemption Certificate. Ask at your Doctor’s for the relevant form, get it signed by your Dr and send it off to the address on the form. A plastic “exemption” card will be sent to you.

I’m on insulin but my doctor is trying to restrict my strips, what can I do?

It would appear that some GPs are trying to restrict the number of strips they will prescribe to diabetics on insulin. This is of course at the urging of the PCTs and their bean counters! Download and print the official advice on testing given by the DVLA which says that you must test before driving and every two hours during a long journey!

Good luck and happy testing!