HOME BLOOD GLUCOSE MONITORING FOR PATIENTS WITH DIABETES
Type 2 Diabetes
Offer self-monitoring of blood glucose to a newly diagnosed type 2 diabetic patient as an integral part of self-management education. Discuss purpose and agree how it should be interpreted and acted upon. Frequent testing is not required in stable well-controlled individuals.
o Self monitoring skills o Quality and appropriate frequency of testing o Use made of the results obtained o Impact on quality of life o Continued
The following criteria should be followed for patients with type 2 diabetes:
All newly diagnosed patients with type 2 diabetes should initially monitor frequently in order to provide them with information in relation to their activities and the effect of dietary measures and treatment prescribed. For patients who are stable, home blood glucose monitoring tests should be done between once and twice monthly(fasting, pre-breakfast). Patients taking Sulphonylureas should monitor at least twice weekly (fasting, pre-breakfast). This applies particularly to patients on longer acting agents. Patients who experience the following should monitor their blood glucose levels more frequently:
If there are difficulties in venesection or if glycosylated haemoglobin is
Glycosylated haemoglobin may be unreliable in the following situations: Patients in whom venesection is not possible. Type 1 Diabetes (and those patients using insulin therapy)
Patients using insulin may need to adapt the frequency of their blood glucose testing due to numerous factors. These include concomitant illness, pregnancy, following a change in treatment, carbohydrate counting, occupational factors such as driving and poor control (plus advice as per point 4 above).
Access to testing strips should not be restricted for this patient group. However, for patients who are stable, we recommend routinely testing blood glucose four times a day (pre-meals and pre-bed) on two days per week. Guidance ratified by the Wirral Diabetes Modernisation Team – July 2009 Review date – July 2010 Recommended Meters and Testing Strips for Wirral Health Economy
The following blood glucose meters and strips are approved for use in Wirral:
Blood Glucose Meter Advantage or disadvantage Testing Strip
Strips expire 3 months after opening so this
meter is only recommended for those patients on insulin or taking a sulphonylurea. It should not be used for patients with type 2 diabetes who test infrequently.
Other Meters with Special Features
Blood Glucose Meter Advantages / Special Features
Disposable meter – obtain a new meter with each supply. For patients using insulin who need to test frequently.
Useful for travelling. Either for holiday use only or use in place of one of the
Sensocard
For the partially sighted or registered blind.
Optium Xceed
Specifically for patients with type 1 diabetes. Blood glucose
testing plus ketone testing as a special feature.
Wirral Diabetes Guideline Working Group
Prof David Bowen Jones – Consultant Physician & Endocrinologist, WUTH Dr Ian R Jones - Consultant Physician & Endocrinologist, WUTH Mrs K Jones – Diabetic Specialist Nurse, WUTH Mrs J Leach – Diabetic Specialist Nurse, WUTH Dr K S Leong - Consultant Physician & Endocrinologist, WUTH Dr J W Lorains – Consultant Physician in Acute Medicine, WUTH Ms F Mcfarlane - Lead Pharmacist for Education and Training, WUTH Dr A Mantgani - Medical Director – NHS Wirral Dr C Raymond - Chair Diabetes Modernisation Team, NHS Wirral Mrs V Vincent – Senior Practice Pharmacist, Medicines Management Team, NHS Wirral Dr S Wynne - Associate Specialist in Diabetes, WUTH Guidance ratified by the Wirral Diabetes Modernisation Team – July 2009 Review date – July 2010Guidelines for Patients HOME BLOOD GLUCOSE MONITORING FOR PATIENTS WITH DIABETES
Many things affect the blood glucose level and this includes what you have eaten and the treatment that you are on, as well as the amount of exercise that you have taken. If you have eaten the wrong kind of food then this may increase the blood glucose to quite high levels. The normal blood glucose level is between 4 and 7 mmol/litre but patients with diabetes have higher readings, although well controlled patients would be considered to have blood glucose levels between 4 and 9.
Type 2 Diabetes Patients with Type 2 diabetes (maturity onset or late onset diabetes) should be taught to check their blood glucose levels on diagnosis of their condition. This means that you will be able to test your blood glucose level to know if your readings are satisfactory or whether you need to change your treatment. One way of testing the blood glucose level is to use the home testing strips with or without a meter. This is best done before breakfast as this gives us the most reliable measurement. We recommend that you test your blood glucose levels frequently following the initial diagnosis of diabetes but once your condition is stable, this needs to be done less often, possibly once or twice a month before breakfast.
However, there are situations when you need to monitor more frequently. These include:
During an illness or infection. Flu, colds and infections such as bronchitis or urine infections can increase the blood glucose level quite markedly. If you have diabetes it is important to know that your glucose level does not increase to a very high level. If this happens, you may need to have additional treatment. Therefore, monitoring your blood glucose level during this time will tell you if any change in your treatment is needed.
If your treatment or tablet is changed for any reason, it is helpful to monitor your blood glucose level more frequently to be sure that the dosage is correct for you and that you are not experiencing any low blood glucose levels (hypoglycaemia).
If your medical treatment includes tablets such as steroids, it is particularly important to monitor more frequently to be sure that your diabetes does not become uncontrolled.
If you are taking one of the tablets called Sulphonylureas (such as Gliclazide, Glibenclamide or Tolbutamide) then these tablets can lower the blood glucose level and cause hypoglycaemic attacks. Therefore, it is important if you are taking these tablets that you should have blood glucose levels measured more often than if you are on other treatment.
Guidance ratified by the Wirral Diabetes Modernisation Team – July 2009 Review date – July 2010 Type 1 Diabetes (and patients with Type 2 diabetes using insulin) For stable patients with type 1 diabetes (and those patients with type 2 diabetes using insulin) blood glucose monitoring is required routinely four times a day (before meals and before bed) on two days each week. However, there are situations when you need to monitor your blood glucose more frequently. These include:
1. As per points 1, 2, 3 and 4 above (on page 3) 2. Carbohydrate
Recommended Diabetic Meters in Wirral
Blood Glucose Meter Advantage or disadvantage Testing Strip
Strips expire 3 months after opening so this
meter is only recommended for those patients on insulin or taking a sulphonylurea. It should not be used for patients with type 2 diabetes who test infrequently.
Other Meters with Special Features Blood Glucose Meter Advantages / Special Features
Disposable meter – obtain a new meter with each supply. For patients using insulin who need to test frequently.
Useful for travelling. Either for holiday use only or use in place of one of the
Sensocard
For the partially sighted or registered blind.
Optium Xceed
Specifically for patients with type 1 diabetes. Blood glucose testing
plus ketone testing as a special feature.
If you are thinking of changing your meter remember to discuss this first with your Diabetes Specialist Nurse (DSN) or Practice Nurse. Test strips are normally specific to each meter and although important to help good control of diabetes, these test strips are expensive. If you have changed your meter, please help us to reduce waste where possible by using up your test strips in your previous meter before ordering the new strips. Wirral Diabetes Guideline Working Group Prof David Bowen Jones – Consultant Physician & Endocrinologist, WUTH Dr Ian R Jones - Consultant Physician & Endocrinologist, WUTH Mrs K Jones – Diabetic Specialist Nurse, WUTH Mrs J Leach – Diabetic Specialist Nurse, WUTH Dr K S Leong - Consultant Physician & Endocrinologist, WUTH Dr J W Lorains – Consultant Physician in Acute Medicine, WUTH Ms F Mcfarlane - Lead Pharmacist for Education and Training, WUTH Dr A Mantgani - Medical Director – NHS Wirral Dr C Raymond - Chair Diabetes Modernisation Team, NHS Wirral Mrs V Vincent – Senior Practice Pharmacist, Medicines Management Team, NHS Wirral Dr S Wynne - Associate Specialist in Diabetes, WUTH Guidance ratified by the Wirral Diabetes Modernisation Team – July 2009 Review date – July 2010
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Qualified vs. Non-Qualified Expenses Health Savings Accounts (HSAs) can help you save in order to pay for many different medical expenses, and using your HSA correctly helps to ensure that these funds are available to you tax-free. HSA funds are to be used to pay for qualified medical expenses in order to be treated as a tax-free distribution. Qualified expenses include products a
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Guidelines for Patients 
