you download to your computer to help you track and visualize your results. These programs can provide trend analysis, averages, graphs, printouts, and more. This can make it easier for you and your health care team to pinpoint any problem areas that might arise. You’ll read more about keeping records of your readings in the logbook section below.
Surprisingly, data management systems don’t cost too much more than regular meters. Before you buy a system, check to see if your health care team uses or recommends one system over another. Also call the manufacturer’s toll-free number, and ask them what you will be getting. They should answer any questions you may have.
Don’t buy a high-end blood glucose data management system unless you can afford the extra cost. Many people find that they can get along with a good logbook. This is especially true if you have type 2 diabetes and monitor less often.
How to Use a Blood Glucose Meter
Follow your meter manufacturer’s instructions for calibrating, setting date and time, and using control solutions. Check to make sure your strips are not outdated, and store them within the proper temperature limits. Strips can be ruined if they are kept outside the range of acceptable temperatures. If you have problems, there is a toll-free number on the back of the meter that you can call for help. Read the instructions for possible test sites.
Equipment
• Lancet
• Test strip
• Cotton ball or tissue
• Blood glucose meter
• Logbook
Instructions
1. Make sure your hands and skin are clean and dry. Soap or lotion on your skin can cause incorrect test results.
2. Puncture the skin where testing is to be done with the lancing device. If there is a problem with potential hypoglycemia, use your finger for testing.
3. Squeeze or milk out the amount of blood needed by the individual meter. With alternative sites, follow manufacturer’s instructions.
4. Follow instructions to see if blood needs to be dropped on the test strip or if the finger or other site should be held so the strip can absorb the blood.
5. Apply firm pressure with a cotton ball or tissue to the lanced site until bleeding stops.
6. Dispose of the lancet and test strip according to local waste disposal laws.
7. Record your test results in your logbook. See more about logbooks below.
Continuous Glucose Monitors
A continuous glucose monitor (CGM) is a small sensor inserted under the skin that measures the fluid between cells called interstitial fluid. This measure correlates to blood glucose. The monitor communicates wirelessly with a handheld device that displays your interstitial fluid level. The sensor must be changed every few days or so. The system can display real-time glucose levels at 1- and 5-minute intervals, and alarms can be set to alert patients of high or low glucose levels. Rapid rate of change can also be displayed. In addition, these systems come with data management software to help patients see readings in trend charts and graphs.
CGMs are more expensive than traditional meters. However, some insurance is beginning to cover these devices.
Although CGMs have not been widely studied, some initial studies have shown that they may beneficial for patients who wear the devices all the time and are highly motivated. For example, continuous glucose monitoring along with tight blood glucose management can lower A1C in adults with type 1 diabetes. Children, teens, and younger adults may benefit, too.
Currently, the FDA requires users to confirm CGM readings with readings from a traditional blood glucose meter before making treatment decisions because CGM devices are so new.
Logbooks
One of the most important tools in your diabetes toolbox is also the most overlooked. A logbook may not look like much, but it will help you and your health care providers understand your blood glucose levels. It will alert you to any red flags that could signal a serious problem and help you determine whether your treatments are working—and how to fine-tune them.
Your health care provider can provide you with a logbook or your meter may come with one. Call the toll-free number for your meter manufacturer to request more. Some manufacturers have logbooks that you can download to your computer and print.
If you like the idea of keeping a paper logbook, you can photocopy blank pages and compile them in a loose-leaf notebook or create your own custom logbook. You may want a lot of room to write in your logbook. Consider buying a spiral-bound notebook or using a loose-leaf notebook, where you can add pages as needed, to jot down extra notes. You may find it useful to have extra space to record different symptoms and situations that could be relevant to your health. Your logbook is an important tool that can help you spot patterns in your blood glucose control, so be sure that it is easy to use.
Some meters come with an electronic logbook that records your readings and allows you to enter comments about your meals or other situations. Some people may prefer the convenience of using an electronic logbook rather than paper. However, you should always keep some type of logbook rather then just storing readings in your meter’s memory.
Ask your health care provider which readings you should write down in your logbook. You should also bring your logbook with you during doctor’s appointments so that you can look over your readings together.
Ketone Tests
People with type 1 diabetes, and occasionally people with type 2 diabetes, can experience a dangerous condition called ketoacidosis. Ketoacidosis is a buildup of ketones in your urine. It can lead to a diabetic coma and death if left untreated. It can happen at any time, but may be more likely during illness, stress, or pregnancy. You can read more about ketoacidosis in chapter 8 about blood glucose emergencies.
Luckily, you can test the ketones in your urine with a urine test strip to make sure you don’t develop ketoacidosis. It’s important to detect ketones before they grow to large levels. Checking for urine ketones is especially important for people with type 1 diabetes who do not make any insulin. People with type 2 diabetes usually produce some insulin, so they are less likely to develop ketoacidosis. However, everyone with diabetes needs to know how and when to check for ketones. Read more about when and how to check for ketones in chapter 8.
Urine Ketone Test Strips
You put a test strip in your stream of urine or in a cup to test for ketones. Urine strips vary in how quickly they show a result, so read and follow the directions so you know how long to wait. A change in color will indicate the presence of ketones. Some strips will indicate ketone levels as 0, trace, moderate, or large, whereas others will give a specific reading. Some urine strips also measure glucose and have two test pads on each strip.
Where to Buy Supplies
People with diabetes now have more choices than ever about where to buy their diabetes supplies and devices. You can shop online, in a local or chain pharmacy, and through the mail. It’s up to you to decide which is the most convenient and cost-effective place to shop. Be wary of online marketplaces where people sell and auction personal items. It is not possible to know if testing supplies have been stored properly or have been altered in any way. Only buy from a reputable source.
Packaging
Individually foil-wrapped ketone strips are the most expensive up front, but they last longer.