Figure 2. Phlebotomy-Drawing Blood With a Lancet
Figure 3. Blood Glucose Testing by Blood Glucose Meter
From USAID. (2013). Phlebotomy-drawing blood with a lancet. (https:// commons.wikimedia.org/wiki/File:Phlebotomy- drawing_blood_ with_a_lancet.jpg). In the public domain. After obtaining an adequate blood sample, touch and hold the edge of the test strip to the drop of blood. Figure 3 is an example of applying blood to the test strip. If there is not an adequate blood sample, the meter will provide an error message signaling the blood sample is not large enough. If a patient reports this happening, the healthcare provider can ask them to demonstrate their meter technique and provide advice. Do not squeeze di- rectly at the site that has been pierced. Squeezing could cause interstitial fluid to leak into the blood sample and lead to a false reading. If an adequate amount of blood is not obtained, the lanc- ing device used to pierce the finger may be too shallow. Most lancet devices offer a choice of lancing depth. Adjusting the lan- cet device to a deeper setting can help produce a larger blood sample. Clarify with patients having trouble getting an adequate blood supply if they are changing their lancet each time; with re- peat use the tip may become dull and result in a less successful finger stick 7 . It is important to note that most meters are slightly different. Always refer to the meter’s user manual for specific in - structions prior to the first use. Frequency of blood glucose monitoring When to prescribe BGM and the frequency of blood glucose checks depend on several factors. There are no universal guide- lines or evidence- based research associated with the ideal fre- quency of BGM. Determining when to test blood glucose levels is individualized for each patient; however, recommendations are available for patients based on medication regimens. The Ameri- can Diabetes Association (ADA) and the American Association of
From Ganguly, B. (2011). Blood glucose testing by blood glucose meter.(https://commons.wikimedia.org/wiki/File:Blood_Glucose_ Testing_-_Kolkata_2011-07-25_3982.JPG). CC-BY-3.0. To reduce the discomfort of BGM, patients sometimes consider using alternative testing sites like the palm, upper arm, forearm, or thigh. There is, however, a wide discordance between blood glucose levels from fingertips and alternative testing sites related to the higher velocity of blood flow through the fingertips. When blood glucose levels change rapidly, the lag between alternative testing sites and fingertips contributes to inaccurate assessment of blood glucose levels. The use of alternative testing sites can provide accurate results when blood glucose levels are not chang- ing rapidly. Box 2 highlights situations when alternative testing sites should not be used. Box 2. Situations Where Alternative Testing Sites Are Not Recommended • Patients who are prone to hypoglycemia • During and after exercise • When the patient suspects they are ill • Before driving • During pregnancy • Anytime blood glucose levels are rapidly increasing or decreasing (within 2 hours ofingesting food) Clinical Endocrinologists (AACE) have standards of care and rec- ommendations that are revised and updated regularly. The 2022 ADA Standards of Medical Care in Diabetes highlight essential information on BGM in the context of therapy and specific goals related to different patient profiles 3,4 . Table 3 summarizes the ADA recommendations for the frequency of BGM.
Table 3. Blood Glucose Monitoring (BGM) Frequency Recommendations Patient Profiles (Medication Regimens) Recommendations Adult patients with type 1 diabetes (Intensive insulin regimen)
4 to 10 times/day. An intensive insulin regimen involves multiple insulin injections/day or insulin pump therapy. Consider monitoring before meals and snacks, occasionally postprandially, at bedtime, before exercise, when hypoglycemia is suspected, after treating hypoglycemia, and when undertaking hazardous tasks like driving. BGM recommended. Evidence is insufficient regarding when and how often to perform BGM. Patients taking basal insulin may benefit from checking their fasting blood glucose daily, as it provides data enabling providers to appropriately adjust the dose of basal insulin. Additional testing before exercise or critical tasks is important if there is a tendency for hypoglycemia. If hypoglycemia occurs, testing should be done until the patients is normoglycemic. Testing when symptoms of hyperglycemia develop, or acute illness occurs will provide data helpful to determine a need for change in insulin or other medication dose. BGM recommended . Although there isn’t sufficient evidence that regular BGM in patients not on insulin therapy improves A1C, doing so may help patients identify the impact of dietary choices and activity level on blood glucose levels. Consider at the time of diagnosis and when helping with problem solving as part of ongoing diabetes self-management education (DSME).
Adult patients with type 2 diabetes (Taking basal insulin with or without antihyperglycemic agents)
Adult patients with type 2 diabetes (On noninsulin therapy)
Adapted from American Diabetes Association 4 .
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