Diabetic Home Care and Monitoring (cont.)
Blood glucose meters
Self–monitoring of blood glucose is the most important tool a patient has to determine their level of glycemic control. This is simple to perform. It involves taking a small lancet, poking the finger (usually it's the tip of the finger, just off to the side, though now there are meters that allow for blood glucose testing to be performed at other sites, such as the forearm). Then a small quantity of blood is placed on a testing strip which is then inserted into a meter where the glucose value is read.
The meter reads the blood glucose level from the reagent strip. Results obtained using a glucose meter are more accurate than those obtained without the meter, that is, with reagent
strips alone. However, the results using a meter are about 10%–15% lower than the more accurate values determined in a clinical laboratory. Meters are accurate enough, however, for home monitoring and adjustment of insulin doses.
It is important to know that reagent strips are calibrated for specific meters. Most meters need to be calibrated once a new box of test strips is used. Inappropriate calibration will lead to errors in glucose readings. Using the wrong strip with a meter is also a source of error in glucose readings. Erroneous results can occur when:
- meters are improperly calibrated;
- the meter is dirty;
- the battery in the meter is dead;
- reagent strips are stored improperly;
- the reagent strips have expired;
- not enough blood is applied to the reagent strip;
- blood is not left on the reagent strip long enough or
is left too long before reading;
- the test is performed under the wrong conditions of
temperature and humidity; or
- patients are dehydrated.
The main advantage of the self–monitoring of blood glucose is that it gives immediate feedback. Diabetics who are educated can make a decision in terms of insulin, diet, and exercise that immediately affects the glucose results. This, in turn, may give them more of a sense of control over their diabetes and may allow them to adapt the diabetes treatment plan to their life style rather than vice versa. Providing regular results to a physician allows for more frequent and accurate adjustments of the medication. This can result in improving symptoms, and diabetic control more effectively, especially in an outpatient setting.
The main disadvantages of the self–monitoring of blood glucose are cost, discomfort, and inconvenience (such as having to interrupt one's usual activities to do it). In addition, some patients experience a feeling of frustration at seeing high blood glucose results when they expected lower readings. "The good thing about blood testing is that I know what my sugar is, and the bad thing about glucose testing is that I know what my sugar is."
The information obtained from self–monitoring of blood glucose is valuable to all patients with diabetes, even those controlled with diet and exercise, and those who require oral medication. Many physicians routinely give all their patients with diabetes a glucose meter, along with an individualized schedule of when to test. This ranges from once a day up to
six times a day, depending on patient needs. Introducing the self–monitoring of blood glucose in conjunction with diet education is very useful.
There are many meters available on the market to choose from that differ in attributes. They may vary in the amount of blood that is used, the speed at which results are displayed, the size of font of the displays, their ability to store readings in memory, and download capabilities. Some meters no longer require calibration. Newer meters function as a health PDA, allowing the patients to enter other lab values, dates, and results of health visits. Newer meters may also store the strips right in the meter, thereby allowing the patient to avoid handling the strips. They may also allow for a patient to flag which readings were after eating and which were before a meal. Examples of glucose meters available OTC are Accu–Chek III, Glucometer Elite XL, and One Touch Ultra.
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