Diabetes-Carmarthenshire

Self monitoring of blood glucose

Patient held records

 

Self monitoring of blood glucose

• Self-monitoring of blood glucose is an important tool for assessing and improving the quality of diabetic control in all types of diabetes

• There is a lack of randomised controlled clinical trials in support of the role of blood glucose monitoring in both type 1 and type 2 diabetes

• The consensus view among diabetes specialists is that home blood glucose monitoring (HBGM) helps to ensure the safety and efficacy of glucose lowering therapies in order to reduce the risk of diabetic complications

• HBGM enables people with diabetes to understand and manage their glycaemic control and assists the clinician in advising on therapy

• The patient must know why, when and how to test, and how to interpret the results. Glucose self-monitoring should be performed only when it serves an identified purpose that is clear to both the patient and the nurse or doctor

• Self monitoring provides patients with information about their day-to-day glycaemic control, enabling them to make appropriate adjustments to their diet or medication, especially in relation to illness, strenuous exercise or potentially dangerous activities such as driving

• It provides the nurse or doctor with information about day to day glycaemic control, enabling them to give appropriate advice e.g. during illness.

• Home blood glucose monitoring can confirm or rule out hypoglycaemia

• Individual assessment needs to be made to advise the patient whether they need to monitor their blood glucose levels or not. These issues should be considered:
  - Is this person at risk of hypoglycaemia?
  - Are we looking for tight glycaemic control with this patient?
  - Will this patient be able to adjust medication according to their results?
  - Does the patient want to monitor their blood glucose levels?
  - Is the patient capable of monitoring his/her own blood glucose levels?

• All patients with diabetes must be made aware of the principles of blood glucose monitoring. They may need to monitor their own blood glucose levels during certain situations. Meters are available free of charge from the hospital or surgery

• Where ever and whichever meter a patient is given, it is the responsibility of that health professional to ensure the patient is taught how to use the meter correctly. It is important that these issues are addressed:
  - Correct use of equipment including meter and finger pricking device.
  - Method and technique of blood glucose monitoring.
  - Potential causes of errors and possible consequences.
  - Disposal methods and storage of equipment.
  - When to test and how often need to be agreed with the patient's nurse or doctor
  - The meter is appropriate for the patient's needs.
  - Consider their dexterity, vision and hearing.

• Ensure they know how to perform the Quality Control Test

• The following equipment is required to test the blood glucose:
  - Blood Glucose meter.
  - Correct blood monitoring strip
  - Coding chip if needed.
  - Finger pricking device
  - Lancets
  - Cotton wool

 

Recommendations regarding blood glucose monitoring
Treatment group	Monitoring regimen
Type 1 diabetes	Blood glucose monitoring should be seen as an integral part of treating type I diabetes. People with type I diabetes should be trained to monitor blood glucose and alter treatment appropriately. The majority of people with type I diabetes are liable to instability of glycaemic control and should therefore monitor blood glucose 4 times per day to prevent hypoglycaemia and treat hyperglycaemia. The following situations indicate the need for more frequent testing: myocardial infarction, dialysis, pregnancy, terminal care, impaired awareness of hypoglycaemia.
Gestational diabetes	Blood glucose should be monitored at least four times per day, to include the fasting state and 2h postprandially.
Type 2 diabetes intensive insulin therapy	As with type 1 diabetes
Type 2 diabetes Once daily long acting insulin or bd mixture	Fasting glucose should be tested at least once per day during titration. It isrecommended that testing be conducted at different times of the day to identify hypoglycaemia. People with type 2 diabetes maintained on daily insulin who are stable and not experiencing hypoglycaemia should test their blood glucose once per day. Those people with type 2 diabetes requiring twice-daily insulins should monitor twice a day at various times to include pre and postprandial and pre-bedtime blood glucose measurements.
Type 2 diabetes Diet and exercise	HbA1c is the real outcome measure in these people. Blood glucose monitoring should not be required routinely. However, people should be trained in blood glucose monitoring, interpretation of the results and appropriate amendments to treatment, as monitoring is required in special circumstances. Blood glucose may require monitoring, for example, once per day at varying times in the following circumstances: •  During a period of illness. •  When therapy is changed. If steroids are co-prescribed (to cover midday, before evening meal and 2 h after evening meal). •  When regular HbA1c testing is not available. •  Patients with postprandial hyperglycaemia (due to the potential link with macrovascular disease).
Type 2 diabetes Metformin or glitazone or both	As for diet and exercise
Type 2 diabetes Sulphonylurea alone or combined with other antidiabetic drugs	Hypoglycaemia is a common occurrence in these people. Blood glucose should therefore be tested to ensure that, if present, hypoglycaemia is identified. Testing of blood glucose is recommended at least 3 times per week. Testing should be undertaken at different times of the day to ensure that hypoglycaemia is identified.

 

Patient held records

Patient held records can
•  serve as an aid to structured care (that is, help ensure that all patients get regular checks on their blood glucose control, eyes, feet, blood pressure etc)
•  help to educate the patient and the health professional in the princples of good diabetes care
•  involve the patient or carer more closely in the care plan
•  facilitate continuity of care when patients move house, change doctors, go on holiday or need emergency care

The Carmarthenshire NHS Trust Diabetes Record Book has been adapted for use in both primary and secondary care settings. It comes as an A5 sized document siutable for filofax format. The following items are included as recommended by Diabetes UK:
•  Patient contact details. Name,address, GP, phone number etc
•  Patient medical details. Type of diabetes, date diagnosed etc
•  Explanatory notes. Why this record is important and how to use it
•  Treatment. Details of all medications
•  Instruction for emergencies. Including treatment of hypoglycaemia and sick day rules
•  Education checklist. Areas to cover in educational sessions such as diet review and footcare
•  Care plan. Giving dietary, physical activity and weight targets agreed between the patient and health professional
•  Diabetes surveillance record. Items to be covered during check-ups
•  Space for patient's personal notes and queries
•  Glossary of medical terms

To print a copy of the Diabetes Record Book click here. Important: To print in standard size load the printer with A5 paper and select A5 double sided on your print menu.