Evidence-Based Practice: Patients with type 1 and type 2 diabetes should be provided with blood glucose monitoring devices as in- dicated by their specific needs, skill level, preferences, and treatment. Blood glucose monitoring is an integral component of diabetes care for patients on an intensive insulin regimen 4 . Patients taking insulin are encouraged to check blood glucose levels when fasting, be- fore meals, before exercise, at bedtime, when low blood glucose levels are suspected, and before carrying out critical tasks like driving. Evidence is insufficient regarding how often BGM is needed for patients who do not use intensive insulin regimens, like those with type 2 diabetes who may take basal insulin with or without oral antihyperglycemic agents. BGM can provide awareness of the impact of healthy eating, physical activity, and medications on blood glucose levels. BGM may also help assess hypoglycemia, blood glucose levels during illness, or discrepancies between A1C and blood glucose levels when there is a concern that an A1C result may not be reliable in some patients 4 . Selecting a blood glucose meter
A variety of different blood glucose meters are available for home use. Choosing an appropriate blood glucose meter for individuals with diabetes requires consideration of several factors. Such fac- tors include availability, cost, visual acuity, manual dexterity, meter size, readout options, optional features (e.g., memory capacity, computer download feature), and patient preference. The cost of meters and testing supplies varies, with insurance companies not always providing coverage. In many instances, initial selection of meter is based on insurance coverage. There are more monitoring options than ever before, from basic to advanced, in design and capabilities. To determine the best option for the individual, it is also important to look at the ease of use and flexibility in where to draw blood samples, while also keeping in mind the cost. The American Diabetes Association provides tools and support to further assist the individual in mak- ing the best decision on available glycemic monitoring devices and technology. If there is a choice of meters, health care provid- ers should present the various options, with selection based on the patient’s needs and preferences. For example, older patients may need a large visual display with test strips that are easy to handle and maneuver. Younger patients may want a small, dis- creet system capable of providing rapid results. Patients with im- paired visual acuity will need a meter that is enhanced with audio. An example of a blood glucose meter, lancing device, and test strip is shown in Figure 1. Ensuring blood glucose meter accuracy Since the 1970s, the accuracy (ability to obtain a true value with- out systematic bias) and precision (ability to obtain highly repro- ducible results) of BGM results has been steadily improving. The accuracy of BGM results depends on blood glucose meter capa- bilities and the person performing the test. The U.S. Food and Drug Administration (FDA) requires all blood glucose meters to meet a minimum performance requirement set by the Interna- tional Organization of Standardization (ISO). For home use BGM, the ISO standard requires 95% of meter results >100 mg/dL to be within 15% of the actual value and 95% of meter results <100 mg/ dL to be within 15 mg/dL of the true value. Several factors can influence the accuracy of test results to include hematocrit levels, ambient temperature, humidity, and plasma levels of ascorbic or salicylic acid. However, the most common reason for inaccuracy in testing is user error. Direct observation of the patient using their meter is the best way to assess their understanding of proper monitoring skills. Patients new to moni- toring should practice using their equipment with a healthcare provider before discharge from the hospital or clinic. It is a good idea for the patient to demonstrate the monitoring technique to a qualified professional at least annually or when devices have been Securing an adequate blood sample Typically, capillary blood samples are obtained from the fingertips. Capillary blood tests are quick and straightforward to perform, requiring a stick to the fingertip and a small drop of blood. How - ever, fingertip testing is associated with considerable discomfort in some patients. Using the side of the fingertip rather than the finger pad lessens the discomfort. To ensure an adequate blood sample, the patient should wash their hands with warm water to increase circulation, hold their hand at their side for 30 seconds to pool blood, and shake their
Figure 1. The Sensor, Needle Holder, and Test Strips
From Celeda. (2020). The sensor, the needle holder, the test strips. (https://commons.wikimedia.org/wiki/File:Capteur_de_ glyc%C3%A9mie_pour_personnes_diab%C3%A9tiques.jpg). CC CC0.
changed. Box 1 summarizes several aspects the patient needs to consider when performing BGM to ensure accurate results. Box 1. Factors to Consider When Performing Blood Glucose Monitoring (BGM) • Be sure the blood glucose meter is clean and free of dried blood. • Ensure hands and fingertips are clean and dry. • Properly store the blood glucose meter and strips (avoid extreme temperature variations and highhumidity). • Use glucose testing strips that have not expired, are compatible with the meter, and defect-free.Check the date on the strip container to be sure they have not expired. • Code the meter if the device needs coding. • Perform a control-solution check with each new container of strips and more often if meter errors aresuspected. • Apply an adequate size blood sample. arm as if shaking down a mercury thermometer. Then load the test strip into the blood glucose meter and put a lancet into the lancet device. A new lancet should be cused with each test. Using the same lancet more than once can cause the lancet to get dull and may cause greater discomfort when piercing the skin. Apply the lancet device against the side of the fingertip and puncture the skin using a consistent amount of pressure. Figure 2 illustrates use of a lancing device to obtain a blood glucose level. After the
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