Glucose Monitoring
Ceri Jones
March 2013
Benefits of Glucose
Monitoring
 Improve glycaemic control?
 Empowerment
 Hypoglycaemia?
 Intercurrent illness/sick day rules
 Pre-pregnancy, pregnancy
 Driving
 Special clinical situations
 Intensive regimens
Reasons for not BGM
Cost
The NHS spends approximately £90 million on blood glucose
testing materials. This is 40% more than on oral
hypoglycaemic agents (£64 million).
Inaccuracies
 Out of date strips
 Contaminated strips
 Incorrect meter calibration
 Meter reading incorrectly
 Sticky fingers
 Incorrect sample size
 Temperature of equipment
Rhondda Cynon Taff
12 months Costs 2003-2004
BGM Guidelines
NSF Standards 3 and 4
 All children, young people and adults with diabetes will receive a
service which encourages partnership in decision-making, supports
them in managing their diabetes and helps them to adopt and maintain
a healthy lifestyle.
 All adults with diabetes will receive high-quality care throughout their
lifetime, including support to optimise the control of their blood glucose.
 All children and young people with diabetes will receive consistently
high-quality care and they, with their families and others involved in
their day-to-day care, will be supported to optimise the control of their
blood glucose.
BGM Guidelines
NICE Guidelines, 2002
 Self-monitoring should not be considered as a stand
alone intervention.
 Self-monitoring should be taught if the need/purpose is
clear and agreed with the patient.
 Self-monitoring can be used in conjunction with
appropriate therapy as part of integrated self-care.
BGM Guidelines
DUK Position Statement
 People with diabetes should have access to home
blood glucose monitoring based on individual clinical
need, informed consent and not on ability to pay.
 The majority of diabetes care is provided by the
individual. It is essential that people with diabetes be
provided with the education and tools in order to be
able to manage their diabetes for themselves.
Glucose monitoring Studies
 ROSSO
 SMBG decreased diabetes-related morbidity and allcause mortality
 SMBG may be associated with a healthier lifestyle
and/or better disease management
 Faas
 SMBG in T2DM patients questionable needs good RCT
 Coster
 SMBG established in clinical practice optimal use not
established.
 Evidence suggests may not be essential for all
Technology
Meters
 numbers available
 Not on prescription
 Coding & quality
control
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Lancing Devices
Professional
Individual patient
Single use
Not on prescription
Lancets
 Available on prescription
Monitoring Errors
 Out of date strips
 Contaminated strips
 Incorrect meter coding
 Incorrect meter
 Hands not clean
 Temperature of equipment
Quality Assurance
 Training
Quality Control
 Accuracy of equipment
 Reliability of results
 Quality Control solutions
 Meter
 Strips
Quality Control
- when?
 New meter
 New test strips
 Change of Batteries
 Test strips left open
 Meter dropped/damaged
 Unexpected result
Failed Quality Control
 Check expiry dates
 Were tests carried out in correct order
 Repeat levels 1 and 2 again
 Change QC solution & Repeat
 Change test strips (change code)
Lancing Systems
Multiple use device with single use
lancet – patients
Single use lancet - professional
Sharps
 Sharps box should be used
 Sharps must NOT be put in rubbish
 Advice if no sharps box
 Sharps disposal service tel: 01443 494700
Factors affecting BG levels
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Food
Exercise
Physical activity
Illness and pain
Medication
OHAs
Insulin
Alcohol
Emotional stress
Home Blood Glucose Monitoring
If stable people
controlled on diet alone
or diet and Metformin
and/or Glitazones and/or
Acarbose should be
taught the principles of
HBGM and if appropriate
should monitor once a
week fasting
If stable people
controlled with Insulin
secretagogues and
diet should be taught
the principles of HBGM
and encouraged to
monitor twice a week
fasting plus at 1 other
time
If stable people
controlled with BD or
OD insulin should be
taught the principles of
HBGM and encouraged
to monitor twice a day 23 times per week.
If stable people
controlled with basal
bolus insulin should be
taught the principles of
HBGM and encouraged
to monitor 4 times a day
2-3 times per week.
Test strips and lancets should not be issued on a repeat prescription.
They should be requested from the practice nurse six monthly or yearly
HbA1c is an excellent indicator of long-term control.
Test more frequently if
Continuing education Monitoring
 Frequency
 Quality assurance
 Coding
 Acting on results
 HbA1c
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Medication is changed
Insulin started
Sick day rules / illness
Risk of hypoglycaemia
Exercise
Advised by DSN or P/N
Driving
Pregnant/planning a family
Patients should not buy their own meters, these will be
provided free of charge via the practice nurse. Practices
to keep a stock of meters (arranged via the diabetes
facilitators) for PWD
 DAFNE
 CSII
There should be no blanket ban on Home Blood
Glucose Monitoring (HBGM) Individual needs change,
some may need to test more frequently than others.
HbA1c is an excellent indicator of long-term control
Contraindications
 Severe dehydration
 Hypotension / Shock / Peripheral
Circulatory failure
 Hyperosmolar non-ketotic Coma
(HONK)
 Diabetic Ketoacidosis (DKA)
Venous sample to lab