Diabetes: The Basics – Monitoring
Listen to Diabetes: The Basics—Monitoring Audio–Note: Audio has not been updated
Diabetes Self-Management- MONITORING – based on the ADCES7 Self-Care Behaviors
Updated 2021 by Kim Ladd, RN, BS, CPHQ, CDCES, and Audrey Demmitt RN, BSN
Tracking your blood sugar levels allows you to make food and activity adjustments to help ensure that your diabetes is being properly managed. It’s also important to monitor your blood pressure, foot health, weight and activity, sleep, emotions and stress, and achievement of goals, to help you stay on the path of good health.
Introduction to Monitoring
Monitoring is defined as observing something and keeping a record of it. In health care situations, you can monitor anything about your body or your response to your care plan that affects long-term health.
If you have diabetes, you need to monitor your own blood sugar (or glucose). In addition, you may need to monitor your weight and blood pressure. You can also monitor your behaviors and feelings, such as what and how much you eat, or whether you feel stressed.
This section covers how to monitor blood sugar levels and has some information about monitoring blood pressure. If you plan to monitor other factors, you will need to decide what to observe, when to observe it, and how to record it.
The information you gain from monitoring will help you, your doctor, and your diabetes educator know if your diabetes care plan is working well for you. Then you can decide, along with your health care team, if you need to make changes.
Monitoring Your Blood Glucose Levels When You Have Visual Impairment
5 Frequently Asked Questions
When you have diabetes, your good health depends on your ability to both monitor and understand your blood sugar level, as well as your blood pressure, weight, and body temperature on sick days. If you have vision loss, there are a variety of large print and talking blood glucose meters, blood pressure monitors, thermometers, and weight scales available, with newer, more advanced models frequently becoming available.
1. What is a “normal” blood glucose reading?
Your blood glucose (blood sugar) will fluctuate throughout the day; however, it should remain within a certain range. Currently, there are two sets of blood glucose recommendations in the United States: the American Diabetes Association (ADA) guidelines, and the joint recommendations of American Association of Clinical Endocrinologists (AACE) and the Association of Diabetes Care and Education Specialists (ADCES).
ADA Recommendations for Adults
• Blood glucose before eating: 98-130 mg/dl.
• Peak blood glucose after eating (one to two hours after meal): less than 180 mg/dl.
• A1C (a blood test done in the doctor’s office): less than 7.0%.
AACE and ADCES Recommendations for Adults:
• Blood glucose before eating: less than 110 mg/dl.
• Peak blood glucose after eating (one to two hours after a meal): less than 140 mg/dl.
• A1C (a blood test done in the doctor’s office): individualized, but generally less than 6.5%.
All three of these organizations emphasize that their recommendations are general guidelines. People with diabetes should work with their doctors and diabetes educators to decide what blood glucose goals are best for them as individuals.
2. How do I set my goals?
Start by discussing options with your doctor. In general, keeping your blood sugar close to normal helps prevent complications; however, you want to keep it high enough to avoid hypoglycemia. For most people, if the blood glucose has been high, it is best to bring it down gradually.
3. What should I consider when purchasing a blood glucose meter?
If you have a visual impairment, your first consideration is accessibility: “Can I read and use it accurately?” When considering a large print meter, check out the size of the numbers on the display and whether the contrast between the print and the background is strong enough for you to read it easily. Minimal glare and the display’s backlighting are also important considerations.
PLEASE NOTE: Take extra precautions if your eyesight fluctuates. This is common among people with diabetes-related vision problems. You vision may be lowest when your blood sugar is highest, and the need to read your monitor is critical. Be sure you can read your meter accurately when your vision is poorest. If in doubt, choose a talking meter.
4. Will any talking meter do?
You will want to weigh your decision carefully. You will want to determine how you will handle your monitoring if certain features are not accessible since not all talking blood glucose meters are created equal. Here is a checklist of features for a talking meter that is truly accessible:
- The instructions for the meter are available in a recorded format.
- The meter speaks or makes some other noise when it is turned on.
- A calibration code is not needed.
- The voice is clear and medium-pitched.
- The meter can be used with an earphone for privacy.
- The meter announces the time and date, and they can be set non-visually.
- The buttons to operate the meter are distinctive, either by placement or by shape.
- The opening for the placement of the strip is easy to feel.
- It is easy to feel which end of the strip to place in the meter.
- It is easy to feel the location of the drop of blood on the strip.
- Only a very small blood drop is necessary for an accurate reading.
- The meter does not give false low readings when too little blood has been applied.
- The meter’s memory is accessible by voice and includes dates and times of all readings.
- The meter speaks or makes some other noise when it is turned off.
- The meter turns off automatically if there is no activity for several minutes.
- Strips are readily available.
- The meter and the strips can be purchased from suppliers that bill Medicare and other health insurance providers such as pharmacies or medical supply companies.
5. Will Medicare or other insurance pay for my meter?
Medicare pays for talking blood glucose meters billed under a special code that allows a higher level of payment than non-talking meters. Most private insurance policies will also cover your talking blood glucose meter; however, each policy is written differently, and some may require you to use a particular brand of meter. Contact your insurance company for clarification.
Before You Buy a Meter
Checking your blood glucose (or sugar) level is something that you can do anytime and anywhere. This can tell you and your doctor how food, physical activity, diabetes medication, and stress affect your blood glucose levels. Choosing a blood glucose meter that suits your needs will help you feel comfortable with checking your blood sugar whenever and wherever you need to.
What supplies do I need to check my blood glucose?
You will need the following supplies:
- Test strips for the meter you are using
- A way to clean your hands
- Lancets and a lancing device (tools used to get a small drop of blood)
How do I decide which meter to get?
Your doctor might tell you what brand of meter to buy or might ask you to choose for yourself. There are many kinds of meters; some are easier to use than others. A diabetes educator, and some pharmacists, can show you different meters and help you choose one. Here are eight (8) questions to think about as you look at meters:
1. Do you like the size and shape of the meter?
Is the meter easy to hold? Will it fit in your purse or pocket?
2. Can you see the display easily?
Is the display screen large enough for you to see easily? Does it have enough contrast? Are the numbers large and thick enough for you to see? Will you use your meter in the dark, for example at night? If so, does it have backlighting?
3. Are the steps for using the meter easy for you?
How do you turn the meter on? Do you need to remember to enter a code number before using a new can of strips? If so, will you remember to do this? How many steps must you do before you get a test result?
4. Are the strips easy for you to handle?
Can you hold them easily? Can you open the bottle? Must you insert the strips one at a time? Do the strips come in a cartridge so you can insert several strips at once?
5. Does the meter have a memory that you will use?
Will you always write down your test result soon after testing, or would you rather rely on your meter’s memory to keep track of your results? How much memory does the meter have? Will that be enough for you? Do you want to be able to keep records of food, exercise and stress in your meter? Do you want a meter that can connect to a computer?
6. Will the battery be easy to replace?
Is the battery easy to find in a store, or do you have to special order it? What does the battery cost? Is it easy to replace by yourself?
7. What will the meter and strips cost you? What will your health insurance cover, and what will you have to pay?
An important part of knowing the cost of a meter and strips is to know what your insurance will cover. If you have any type of health insurance, including Medicare and Medicaid, it will probably cover a blood glucose meter and strips. Remember that after you buy a meter, you have to buy the strips that go with it. Because you will keep using strips every day, the strips are the most expensive part of blood sugar monitoring. Check what your insurance company will cover before you buy a meter. You can call the number on the back of your insurance card. Your insurance policy might pay for only a certain brand of meter and strips, or it might cover a certain brand at a higher level. It might have a limit on the number of strips it will cover each month or it might only cover meters and strips if you buy them from a specific supplier. Also, you will need a prescription from your doctor before your insurance covers a meter and strips. If you are paying for your own meter, you do not need a prescription.
8. Where should you buy a meter and strips?
You can buy a meter at a pharmacy, a medical supply store, or online. Think about whether it will be easier for you to buy more strips from a local store, a medical supply store, or online. Another factor is that most suppliers, but not all, will fill out the paperwork to bill your insurance company. If your insurance covers meters, and the place you buy one does not fill out insurance paperwork, be sure to keep the receipts to file the paperwork yourself.
Blood Glucose Meters with Speech Capability
If you’ve been certified as legally blind, it’s likely you’ll meet the requirements of most insurers to obtain a blood glucose monitor with speech capability, also called a talking blood glucose monitor. Be aware that talking monitors fall into two categories – those with partial speech and those with full speech. Those with partial speech may only announce your blood glucose result, while meters with full speech announce your result but also announce the results in memory, low battery warning, and audible steps to set the time and other monitor features. Current full speech meters include:
To learn about the full range of blood glucose monitors currently available, see this consumer guide from the American Diabetes Association.
After You Buy a Meter
- Learn how to use your meter properly.
A diabetes educator can teach you how. All meters come with instruction booklets and some with videos. Read the booklet and watch the video. Pay special attention to whether you need to set a code number to match each can of strips, how to apply blood, and how to clean your meter.
- Protect your test strips.
Sunlight, cold and humidity can ruin strips. Keep them in the box or bottle they came in. Close the box or bottle after taking out a strip. Do not use test strips past the date on the box (expiration date).
- Learn how to do control solution checks.
These tests tell you if the meter is in good working order.
- Know how to get help if you need it.
Most meters have a toll-free number on the back. If you have questions about how to use your meter, call the number or contact the manufacturer online.
Seven steps for checking your blood sugar level
- Gather the supplies you need: a meter, lancets, lancing device, test strips, and a tissue or cotton ball.
- Load your lancing device with a lancet.
- Wash your hands with warm soapy water and dry them.
- Insert a test strip in your meter.
- To get a drop of blood: hold the lancing device firmly to your finger and press the button.
- Put the drop of blood on the test strip. Then use a tissue or cotton ball to stop the bleeding.
- Your blood sugar level will show up on the display screen in a few seconds. Record your result.
Hypoglycemia: Low Blood Sugar
What is hypoglycemia?
Hypoglycemia, or low blood sugar, is blood sugar below 70 mg/dl. People taking insulin or some diabetes pills can have hypoglycemia. Hypoglycemia must be treated immediately.
How will I know if my blood sugar is too low?
Mild symptoms of hypoglycemia:
- Weak or tired
- Chills or cold hands
- Pale skin color
- Trouble sleeping
Moderate symptoms of hypoglycemia:
- An increase in the mild symptoms
- Confusion, unclear thinking
- Trouble with your sense of balance
- Difficulty speaking
- Numb lips
- You pass out
- You cannot be awakened
- You have seizures
If you have mild or moderate symptoms, check your blood sugar using a meter.
- Treat any blood sugar below 70 mg/dl.
- Some people should treat blood sugar below 80 mg/dl.
It is important to treat hypoglycemia right away, while symptoms are mild to moderate, so your hypoglycemia does not get worse. If you cannot check your blood glucose level and you have symptoms, treat for hypoglycemia right away.
How should I treat hypoglycemia?
If you are awake, eat or drink something containing about 15 grams of sugar. Some good choices are:
- 4 glucose tablets
- 1 tube glucose gel
- 4 ounces (1/2 cup) of orange, apple, or other fruit juice
- 4 ounces (1/2 cup) of regular soda (NOT diet)
- 2 teaspoons of jam, jelly, or syrup
- 7 small hard candies (like Lifesavers)
- 1 cup of low fat milk
Wait 15 minutes and recheck your blood sugar. If it is not coming up, eat 15 more grams of sugar.
You will need someone else to help you if you are not awake. Plan ahead! Make sure your family members know what to do. Tell someone at your workplace and any other place where you spend a lot of time. Tell them:
- Do not try to give you food or drink if you are unconscious. This could make you choke.
- If you are unconscious, call 911.
Your doctor might prescribe glucagon for you. This is an injection to help raise blood sugar fast. A family member should learn how to use it.
After your hypoglycemia is over, try to figure out what caused it. This will help you prevent it in the future.
Some Causes of Hypoglycemia
- Skipping meals or snacks
- Not eating at the right time
- Not eating enough food
- Increased physical activity or exercise
- Not taking medication at the right time(s)
- Accidentally taking too much insulin or diabetes pills
- Drinking too much alcohol
How can I prevent hypoglycemia?
- Know the effects of your diabetes medication, and eat to match its strongest action times.
- Plan your physical activity to fit with your eating and medication actions.
- Monitor your blood sugar, keep records, and know your reactions.
- If you have hypoglycemia more than two times in one day or more than three times in one week, talk to your doctor or diabetes educator.
If you use insulin or have ever had hypoglycemia, be prepared:
- Wear and carry diabetes identification, such as a bracelet or necklace and a card in your wallet.
- Keep a source of simple sugar with you at all times — in your purse, glove compartment of your car, backpack, or pocket.
- Be sure that family members, co-workers, friends, teachers, and coaches know that you have diabetes and know what to do if you are confused or pass out.
What is hyperglycemia?
Hyperglycemia is high blood sugar (glucose).
If hyperglycemia lasts for a long period of time, it can cause damage to your eyes, kidneys, heart, blood vessels and nerves. A blood glucose level of 180 mg/dL or above is considered hyperglycemia.
Studies have shown that complications from diabetes can be delayed or prevented by keeping blood glucose levels in these target ranges:
- Before meals or fasting: 80-130 mg/dL
- Two hours after a meal: less than 180 mg/dL
Talk with your doctor or diabetes educator about what your blood glucose target range should be. It could be different from those listed above depending on your age, your diabetes treatment plan, and other health conditions.
Is hyperglycemia ever an emergency?
Yes, it can be. Very high blood glucose —above 300 mg/dl —can cause serious problems quickly. High blood sugar can cause dehydration. It can also cause very serious conditions called Diabetic Keto-Acidosis (also known as DKA) or Hyperglycemic Hyperosmolar Non-ketotic Syndrome (HHNS). These are medical emergencies and must be treated at a hospital.
How will I know if my blood glucose is too high?
Blood glucose levels vary throughout the day. How you feel is not a good way to tell if your blood glucose is high. It is best to use a glucose meter several times each day or use a continuous glucose monitor (CGM) to measure your blood glucose levels. Record these results in a logbook, in the memory of your glucometer or an app, and show them to your doctor and diabetes educator at each visit.
Common symptoms of high blood glucose
- Frequent urination
- Increased thirst
- Increased hunger
- Tiredness, lack of energy
- Blurred vision, difficulty seeing clearly
- Slow-healing wounds or infections
You can have high blood glucose with different, more unusual symptoms, or without any symptoms at all. That is why it is important to monitor your blood glucose.
Five Common Causes of Hyperglycemia
- Not enough physical activity. Regular physical activity can lower your blood glucose levels during exercise and several hours after. But do not exercise if your blood glucose is over 300 mg/dL.
- Too much food or eating at the wrong time. See a dietitian, so you can have a meal plan designed to fit your needs and your life.
- Forgetting to take your diabetes medication or taking it at the wrong time. Talk to your doctor, diabetes educator, or pharmacist about the proper way to take your diabetes medications. If you forget your medication a lot, ask your diabetes educator to help you find ways to remember. If you take some medicines more than once a day, you can also ask your doctor about changing to longer-acting medications.
- Being sick. Talk to your physician about a sick day plan so you can manage your diabetes when you are ill.
- Stress, emotional upset, or feeling anxious. Try to find ways to reduce stress like exercising, reading a book, or using relaxation techniques like deep breathing.
What should I do if I have high blood glucose?
Continue to take your diabetes medications and test your blood glucose more often. Call your physician if your blood glucose stays above 240 mg/dL OR is above 300 mg/dL two times in a row. Drink 6 – 8 ounces of calorie free, caffeine free liquid every hour to avoid dehydration. Check your urine for ketones, toxic substances your body produces when burning fat for energy. If you have a moderate or large amount of ketones, call your physician.
Monitoring Your Blood Pressure
Many people who have diabetes also have high blood pressure. Controlling your blood pressure is just as important in preventing diabetes complications as controlling your blood sugar levels. In fact, some doctors think it might be even more important.
The American Heart Association recommends that everyone with high blood pressure monitor it at home. This can help you to control your blood pressure, for many of the same reasons that monitoring blood sugar levels can help. It is normal for blood pressure to vary throughout the day, but it should stay in a healthy range. Monitoring your blood pressure can tell you and your doctor whether your meal plan, exercise, and medications are working to control your blood pressure, or whether you need to make changes.
How should I choose a blood pressure monitor?
For accurate readings, a monitor should have a cuff that:
- Wraps around the upper arm.
- Inflates automatically. This is much easier to use by yourself, rather than a cuff that must be inflated by hand.
- Fits your arm. If you have a large arm, a small one will not give an accurate reading.
You can buy talking blood pressure cuffs from specialty medical supply companies such as:
Will my health insurance cover the cost of a blood pressure monitor?
- Most policies do not. Call the number on the back of your insurance card to find out if yours does.
When and how should I measure my blood pressure?
For many people, it’s a good idea to measure your blood pressure twice a day, in the morning and the evening. You can follow these 5 steps:
- Sit in a chair, with your back straight, your feet on the floor, and your arm supported at about heart level. For example, sitting by a table can give you a place to support your arm and place your blood pressure monitor.
- Sit still for about 5 minutes before you measure your blood pressure.
- Wrap the cuff around your arm, as shown in the instructions that come with the cuff.
- Inflate the cuff, take your reading, and write it down.
- Wait about a minute, and take another reading. Then take a third one. Keep a record of all 3 readings, either by using a meter with a memory, or by writing them down.
What is normal blood pressure?
A normal blood pressure reading is less than 120 (the systolic pressure) over less than 80 (the diastolic pressure). The top number measures the pressure in the blood vessels when the heart is beating, and the bottom number when the heart is relaxing. Both numbers are important.
What should I do with my blood pressure readings?
- Look for patterns in them, just as you do with blood sugar readings. Notice how stress, different types of exercise, and different foods affect your blood pressure.
- Take your blood pressure readings with you when you go to the doctor, so you can discuss them.
- If you have higher than normal readings several days in a row, call your doctor.
- If your systolic pressure is higher than 180, or your diastolic pressure is higher than 110, you need emergency medical treatment. Call your doctor for an immediate appointment or go to the emergency room.
Know what the numbers in your blood pressure reading mean:
Diabetes and Vision Loss Tips: Monitoring – VisionAware