Monitoring Glucose and Other Tests Tips

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How often should I monitor my blood sugar?

Frequency of Blood Sugar Monitoring

The frequency of blood glucose monitoring (fingersticks) will vary depending on the individual, and including:

1) Type of diabetes
2) Type of medication
3) Medication delivery system
4) Lifestyle

In general, those with less well-controlled disease will need to test more frequently.

For those utilizing sliding scale insulin --usually newer Type I diabetics, or those with brittle disease -- it is recommended to check your sugar 4 times each day: once before each meal and then at bedtime.

If you are stable with only occasional fluctuations, one or twice a day may be adequate.

If you are a Type II diabetic, your physician may not even require fingersticks on a daily basis, depending on the number and type of anti-diabetic medications that you are taking.

Talk to your doctor about your disease to see what frequency of testing would be the best for you.

   
How do I check ketones?

Monitoring Ketones

When the body does not have sufficient insulin to use glucose for energy, it will try to use fat instead. After a while, by-products of fat metabolism appear in the bloodstream. These are called ketones.

Ketones are usually noticed when they start to spill over into your urine, or are expelled through your lungs, as the body attempts to filter them out of your blood. When ketone levels are high, you will notice a fruity smell to the breath, that is reminiscent of alcohol. The urine odor also changes.

Ketones are a toxic by-product of fat metabolism, and signal a serious problem in the management of your disease. High blood levels of ketones can cause coma and death, if left untreated.

Urine dipsticks are available that can test for the presence of excess sugar and ketones in your urine. Well-controlled diabetics rarely spill ketones into the urine, as ketone production is an indicator of high blood sugar levels and unstable diabetes.

Talk to your doctor about how frequently he or she wants to you check your ketone status. When in doubt, check it out!

   
What are the monitoring tests a person with diabetes needs?

Monitoring your diabetes

There are several tests that are normally done for the person with diabetes, to monitor their health and control of the disease. These tests include: 1) blood glucose testing, 2) hemoglobin A1C, 3) lipid levels, and 4) microalbumin.

Blood glucose is monitored from once a day to four times a day, at the direction of the physician. Using a lancet device to obtain a drop of blood for your finger is the most common way of checking blood glucose. Additionally, your physician may have a lab draw blood samples to compare lab results with your daily fingerstick results.

Hemoglobin A1C reflects the overalls status of your disease. Normal values are less than 6.0. This test shows how well your disease is controlled and will be above normal values if your blood sugars tend to be high on a regular basis.

Lipid levels are evaluated to monitor the effects of your diabetes on the cardiovascular system. It is not uncommon to have elevated cholesterol and triglycerides when your blood sugars are not well-controlled. This places you at risk for heart attack and stroke.

   
What is the hemoglobin a1c?

Hemoglobin A1c and Diabetes

The red blood cells in your blood contain hemoglobin, which helps to carry oxygen. This hemoglobin will also bind with other substances, including glucose, by a process known as "glycolation."

When a blood sample is drawn and tested for the levels of glucose bound to the hemoglobin, the result is known as a Hemoglobin A1c, or glycolated hemoglobin.

Normal values may vary slightly with different labs, but the normal for a non-diabetic at many labs is 4.0 to 6.0. Many studies of diabetes, have demonstrated that diabetics with a glucose closer to this goal range have less complications.

The Hemoglobin A1c will give information about the overall average range of glucose levels over the past three months (this is how long red blood cells live before being renewed), especially for the weeks prior to the test. It will give a picture of general glucose control, along with results of blood glucose monitoring values.

The Hemoglobin A1c does not replace regular glucose monitoring, but can be a useful tool in learning how well a person's diabetes is being controlled.

You will want to discuss with your medical provider your individual goal for your Hemoglobin A1c.

   
How do I get a good blood sample for checking glucoses?

Getting an Adequate Fingerstick Blood Sample

At times, it can be difficult to get a good blood sample from a fingerstick, especially on a cold day, or if circulation is poor to the fingers. Here are some tips to help:

1) Rotate fingers: if a person always
gets a blood sample from the same
spot, a callus can build up and the
needle may not puncture adequately.
It is best to obtain a blood sample
slightly to the side and just
beneath the tip of the finger, not
on the tip directly, to prevent
soreness.
2) Wash or soak the hand in warm
water just before monitoring: this
brings blood to the surface of the
fingers
3) Gently "milk" the blood into a round
drop, starting at the base of the
finger, and squeezing gently to the
tip
4) Place the hand below hip level for
30 seconds to increase blood to the
hand and fingers or shake your hand
down to bring blood to the finger

Many of the newer monitors need less blood to get an accurate reading, and some actually wick a tiny sample into the sensor strip.

If none of these are consistently effective in getting a good sample, talk to your doctor about alternative sampling sites.

   
What can cause an error in blood sugar readings with a meter?

Erroneous Blood Glucose Readings

Accurate blood glucose measurements are important, since decisions about medication adjustments, meal plans or activity are based on them. But, what can cause an erroneous reading?

1) Outdated or unusable strips - check
the expiration date on your strips.
Strips that are outdated will not
give an accurate reading.
2) User error - learn how to use your
glucose monitor. It is best to have
a nurse or other healthcare
professional teach you the best way
to use your monitor, especially when
you get a new one.
3) Wrong calibration chip/code for the
strip being used - check the code on
the bottle of stips, and make sure
to calibrate your monitor to the
correct code
4) Meter needs cleaning - sometimes
blood can cloud the sensor,
depending on the type of meter you
have. Follow the manfacturer's
instructions for cleaning your
machine and set up a schedule for
routine maintenence.

If after you have tried these tips and you still cannot get an accurate reading, contact your healthcare provider for a replacement monitor or additional guidance in problem-solving.

   
What is microalbumin?

Microalbumin and Diabetes

Albumin is a protein that occurs in the blood stream. Normally, the kidneys filter it out of the urine, but when nephropathy (kidney disease) occurs, as a complication of diabetes, they can no longer do this, as well. This results in protein being abnormally present in the urine.

Microalbuminuria is the presence of minute amounts of protein in the urine. Regular testing for its presence is important, since it is one of the first indicators of early kidney disease.

Early treatment of nephropathy is important, as the kidneys impact not only waste filtration and removal, but also blood pressure. Early intervention can help to save kidney function.

For the person with Type 1 diabetes, screening should be done for microalbumin within 5 years of being diagnosed. For the person with Type II diabetes, this test should be done when they are diagnosed and then on a yearly basis.

Talk to your doctor about testing for microalbuminuria.

   
How can I use the information I obtain from blood glucose monitoring?

Using Your Blood Glucose Readings

The purpose of blood glucose monitoring is to learn how activity, meals, and medication are affecting your blood glucose levels.

Generally, you want your blood glucose values between 80 and 120. Evaluating your blood glucose readings can help you properly adjust your medications, diet and activity to keep you healthy and free of potential complications.

If you have Type I diabetes and your evening values tend to be high, look at your lunch meal. Increasing afternoon activity can help regulate this, as well. Morning insulin dosage may need to be adjusted if diet and activity changes do not lower your glucose readings.

For Type I, if your morning glucose values are high, look at your bedtime snack, and evening insulin dosage.

Since insulins have different lengths of activity, the intermediate or long-acting types give you better 24-hour coverage than sliding scale, with less fluctuations. This is a good place to focus when deciding on an insulin.

Short-acting insulin helps to regulate fluctuations in your sugars related to diet events, periods of illness or changes in physical activity.

For those with Type II diabetes, the focus is on food choices and activity.

Regardless of the type of diabetes that you have, talk to your doctor about how to best stabilize your blood sugars through the combination of diet, activity and medications.

   
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