 Please remember all changes in insulin regimens must be discussed with your diabetes team first!!! Below is information to assist you in being more informed when speaking with them.
Check out our new section of diabetes related terms!
Blood Glucose Testing
Testing can be done using the tips of the fingers, as well as Alternate Site Testing (AST) on such places as the sides of the hands, the forearm and the leg. When in doubt or if a low is suspected always use the finger tip for most reliable results. While most people do not find a time lag when using AST, current research recommends that lows be monitored through finger testing.
Why is it important to test?
In order to properly control your diabetes, it is important to know what you blood glucose levels are. Too high or too low can lead to disastrous complications.
When to test?
This depends on if you have Type 1 Diabetes or not and how active you are. Current Canadian Diabetes Association Clinical Practice guidelines suggest 6 times per day. Many doctors suggest testing before each meal, before, after and during strenuous physical activity, and before bed. It may also be preferable to test at least once throughout the night to ensure that nighttime basal insulins are working properly. Please consult with your diabetes team to see how often you should test your blood glucose levels.
But what does "blood glucose testing" mean?
Glucose is a type of sugar. The body forms glucose when it breaks down the food we eat into a useable form of energy. Glucose is the body's main source of energy. Measuring the amount of glucose found in your blood helps to show how the body is breaking down food into energy, as well as how the liver is working.
Blood glucose testing may be Fasting--which is done after you have not eaten for 12-14 hours and is often used in a clinical setting to diagnose diabetes. It may be a 2-hour Postprandial test which is testing done 2 hours after a meal. Finally, Random testing can be done. This testing that occurs at various times throughout the day.
What do those numbers on the meter mean?
| Over 10 mmol/L |
Over 180 mg/dl |
Hyperglycemia--Caused by greater than normal levels of glucose in the blood. Can produce symptoms such as thirst, frequent urination, fruity smelling breath, and lethargy. If left untreated prolonged hyperglycemia can lead to such complications as heart and kidney disease, neuropathy, and erectile dysfunction. |
Insulin adjustment may be needed. Consult with your diabetes team |
| 5-10 mmol/L |
90-180 mg/dl |
Normal range within two hours of eating a meal |
|
| 4-7 mmol/L |
72-126 mg/dl |
Normal range after fasting |
|
| under 4 mmol/L |
under 72 mg/dl |
Hypoglycemia--occurs when the blood glucose level drops too low. Symptoms may include sweating, trembling, fatigue, dizziness, moodiness, confusion, blurred vision and/or hunger. Immediate treatment with fast- acting sugar (such as 1/2 cup of regular pop, 1/2 cup of juice or 3 glucose tablets) is required. Retest after 15 minutes. If left untreated, the person may become unconscious, have a seizure and possibly die. If the person is unconscious do NOT administer anything by mouth. Inject Glucagon according to instructions provided. |
Insulin adjustment may be required. Consult with your diabetes team. |
Please remember that the above information is simply a guideline and in no way replaces medical advise. Please speak with your doctor or diabetes care professional to determine what blood glucose levels are optimal for your care. The above guidelines are based on the Canadian Diabetes Association's 2003 Clinical Practice Guidelines.
Important information about AST
* Under certain conditions, blood glucose test results obtained using samples taken from your arm may differ significantly from fingertip samples.
* The conditions in which these differences are most likely to occur are when your blood glucose is changing rapidly such as following a meal, an insulin dose or associated with physical exercise.
* When blood glucose is changing rapidly, fingertip samples show these changes more quickly than arm samples.
* When your blood glucose is falling, testing with a fingertip sample may identify a hypoglycemic (low blood sugar) level sooner than a test with an arm sample.
* Use arm samples only for testing prior to, or more than 2 hours after, meals, insulin dosing or physical exercise.
* Testing performed within two hours after a meal, an insulin dose or physical exercise, or whenever you feel that your glucose levels may be changing rapidly, should be done from the fingertip.
* You should also use fingertip testing whenever you have a concern about hypoglycemia (insulin reactions) such as when driving a car, particularly if you suffer from hypoglycemic unawareness (lack of symptoms to indicate an insulin reaction), as arm testing may fail to detect hypoglycemia.
 Testing on the side of the hand using the Freestyle Mini ™ (Freestyle Flash in the US) by Therasense. The FreeStyle Mini uses .3 microlitres of blood in its sample size. Backlight lights up readings as well as test strip. Great for night testing.
 AST. Testing on the forearm with the FreeStyle ™ Mini
 Precision Xtra ™ uses .7microliter of blood. It provides blood glucose results in five seconds. This new Precision is much smaller and with an improved lancing device and smaller carrying case. The ketone strips remain the same in sample size and result time. Ketone testing through blood is more accurate than urine tests and should be used when ill or hyperglycemic.
More meters and their features...
 Ascensia® CONTOUR™ Blood Glucose Monitoring System requires no coding of strips. Uses .6 µL blood sample. Results in 15 seconds. Can be used to do AST. No backlight. 
 Ascensia™ BREEZE™ Blood Glucose Monitoring System uses 10 strip Autodisk. Auto codes each disk for easy use. Uses 2.5 to 3.5 µL blood sample.
 Accu-Chek Aviva Comes with six lancets in a preloaded drum. Gives results in 5 seconds and provides up to 4 test reminders throughout the day. Wide, easy to handle strips require sample size of only .6 µL of blood.
 OneTouch® Ultra®2 The OneTouch Ultra2 is currently NOT available in Canada. It is however available in the US.
It uses end-fill test strips that are very easy to fill and take only 1 microliter of blood. The strip is is touchable and is approved for alternative sites. Besides now offering 3 easy to use buttons, the OneTouch Ultra2 has the ability to mark a reading as pre-meal or post-meal to help you learn about the effects of various foods on blood glucose levels.
Key features of the OneTouch Ultra2 include:
* Fast test results -- 5 seconds
* Small blood volume (1 microliter)
* Alternative site testing
* Small size and weight (easily fits in a kid's T-shirt pocket)
* End-fill test strips that can be touched
* Widest temperature range of any strip
* A 500-test memory for storing blood sugar readings
* 14- and 30-day averaging
* Large, easy-to-read display
* Data interface port
* Uses two lithium watch batteries, one for the meter (rated for approximately 1,000 tests) and one for the backlight
* Displays blood sugar readings in mg/dL or mmol/L (factory set per country)
* Three year warranty
What is the difference between testing and using a Continuous Glucose Monitor?
Glucose meters are portable devices that read glucose levels from a blood sample that is placed on a tiny test strip. Test strips are discarded after a single use. Some meters store a limited number of glucose results in memory. The results can be downloaded into a computer.
A glucose sensor is a tiny electrode that is inserted under a patient’s skin (subcutaneous tissue) and continuously records glucose levels around the clock. The sensor is worn for up to three days before it is discarded and replaced by the patient. Glucose readings are transmitted to a monitor or insulin pump
where the values are displayed. Trend reports and charts can
be viewed after data is downloaded to a computer.
posted with permission from 2006 Medtronic MiniMed, Inc.
A1c...What does it mean?
A1C (or Hb A1c) is a measure of how much glucose is stuck to your hemoglobin. Hemoglobin is a protein inside your red blood cells. It is the part of the red blood cell that carries oxygen from your lungs to the rest of your body. Hemoglobin also carries glucose, because glucose can stick to all kinds of proteins in your body. Once glucose sticks to hemoglobin, it is stuck there for the life of the red blood cell, about three or four months. The more glucose there is in your blood, the more will end up stuck to the hemoglobin. Your A1C reading tells you what your average blood glucose level has been over the last two or three months. If you have lots of glucose in your blood and your average blood glucose has been high for the past few months, then your A1C will be high. Canadian Diabetes Clinical Practice Guidelines recommend that anyone living with diabetes have their A1c checked every 6 months. For more details go to the Ascensia website
| A1c |
mmol/L |
mg/dL (US measure) |
Meaning |
| 14.0% |
20.0 |
360 |
Very poorly managed, take immediate action to lower |
| 12.0% |
19.5 |
345 |
|
| 11.0% |
17.5 |
310 |
|
| 10.0% |
15.5 |
275 |
Poorly managed, take action to lower |
| 9.0% |
13.5 |
240 |
Poorly managed, take action to lower |
| 8.0% |
11.5 |
205 |
|
| 7.0% |
9.5 |
170 |
Within DCCT recommendations to reduce complications |
| 6.0% |
7.5 |
135 |
Very well-managed |
5.0%
|
5.5 |
100 |
|
| 4.0% |
3.5 |
65 |
|
*These are just guidelines. Please check with your doctor to see what he/she recommends for your diabetes care!!
Postprandial Readings
The postprandial reading is that reading taken 1 hour after a meal. Ideally, for children under 5 years old the reading should be under 13.7 mmol/L (250mg/dl). For children 5-11 years old, the reading should be under 12.5 mmol/L(225 mg/dl) and adults would aim to keep it under 11.1 mmol/L(200 mg/dl). It is felt that high postprandial numbers may account for higher A1c readings. High postprandial readings may also lead to kidney disease 9 years earlier than in those with lower readings.
For many people, postprandial ideals are hardest to achieve after breakfast. One way to avoid this "spike" is to look at adjusting the time at which one boluses. If the bg levels are low before breakfast and you have having a low Glycemix Index meal, you may wish to bolus within 15 minutes of the meal. If you have a high bg level and a high glycemic index meal, one would try to boluss 15-20 minutes before the meal. For normal to moderate glycemic index meals, one would one to bolus about 5 minutes before the meal.
Another option is of course to try John Walsh's "super bolus". This incorporates some of the basal rate into the initial bolus.
From Gary Scheiner's Strike the Spike
Insulins Available in Canada
| Type |
Name |
Start to Work in |
Peak Action |
Duration |
| Fast-acting Insulin |
Apidra®
Humalog®
NovoRapid® (Novolog® in US) |
15-20 minutes
5-15 minutes
10-20 minutes |
n/a
1/2-1 1/2 hours
1-2 1/2 hours |
n/a
3 1/2-4 1/2 hours
3-5 hours |
| Short-acting Insulin |
Regular (R) or Toronto |
30-45 minutes |
2-4 hours |
3-7 hours |
| Intermediate-acting Insulin |
NPH (N) or Lente(L) |
1-3 hours |
2-14 hours |
4-16 hours |
| Long-acting Insulin |
UltraLente(U) |
2-4 hours |
4-18 hours |
18-24 hours |
| 24-hour basal Insulin |
Glargine (Lantus®)
Insulin Detemir (Levemir® |
1-2 hours
1-3 hours |
6 hrs
8-10 hours |
18-26 hours |
| PreMixed Insulin
(%R/%N) |
10/90, 20/80, 30/70,
40/60, 50/50 |
1/2-1 hour |
2-12 hours |
18-24 hours |
| Premixed insulin analog |
analog Humalog® Mix25™ |
5-15 minutes |
1/2-12 hours |
18-24 hours | based on data from the Canadian Diabetes Association and http://www.diabetesnet.com/diabetes_treatments/insulin_action_times.php
Illness
Below is general information regarding sick day management. It is not meant to replace the advise of your healthcare professional. Should you require further information regarding your condition or treatment, PLEASE speak with your healthcare professional.
- Always take some insulin (even if vomitting). When you are ill you may actually require more insulin as you may have higher blood glucose levels despite eating less.
- Always check your blood sugar and ketones. Whether you are high or not, you should always check for ketones when ill. It is preferable that you check for blood ketones as it gives a more real-time reading than urine. Blood ketones can be tested for by using the Precision Meter with the proper blood ketone strips (these strips are significantly more expensive than the regular blood glucose test strips.)
| Blood Ketone Reading |
Action Needed |
| <0.6 mmol/L |
Use usual insulin dose as for non-sick days |
| >0.6 mmol/L |
Take a 10% (of TDD) supplement of rapid or fast-acting insulin, in addition to usual baseline insulin doses |
| <0.6 mmol/L |
Take a 10% (of TDD) supplement of rapid or fast-acting insulin, in addition to usual baseline insulin doses |
| >0.7-1.4 mmol/L |
Take a 15% (of TDD) supplement of rapid or fast-acting insulin, in addition to usual baseline insulin doses |
| >1.5-3.0 mmol/L |
Take a 20% (of TDD) supplement of rapid or fast-acting insulin, in addition to usual baseline insulin doses CALL YOUR HEALTHCARE TEAM AS SOON AS POSSIBLE! |
The above was developed at the Leadership Sinai Center for Diabetes, Mt. Sinai Hospital, Toronto with an educational grant from Abbott Laboratories, Limited, MediSense Products (9-02)
Important information on Ketone Testing
Two recent studies (February 2006) demonstrate clear medical benefit from blood ketone testing. The first study (Diabetic Medicine 23 (3),
278-284) showed a significant reduction in hospitalizations during sick days (38 vs. 75 per 100 patient days) for people who used blood ketone testing compared with urine ketones testing. Staying out of the hospital is a very powerful argument for using blood ketone testing. The second study (Diabetes Technol Ther. 2006 Feb;8(1):67-75) showed that, for patients using insulin pumps, blood ketone testing could identify interruptions in insulin flow faster and more accurately than even blood glucose monitoring and could thus help pumpers prevent DKA better than if they didn't use blood ketone testing.
From Jeff Hitchcock, www.childrenwithdiabetes.com See their Care Suggestions page for more information.
Using Glucagon During Illness for Children with Type 1 Diabetes
This is not meant to replace the advise of your healthcare professional. Should you require further information regarding your condition or treatment, PLEASE speak with your healthcare professional.
A team from the Texas Children's Hospital Diabetes Care Center came up with a novel idea: use very small doses of glucagon, injected subcutaneously using a regular insulin syringe, to stave off hypoglycemia in kids with a stomach illness (gastroenteritis) or who were not cooperating and needed food. Whereas a typical glucagon injection delivers 500 to 1,000 µg, the Texas Children's team suggested the following dosing schedule:
* 20 µg for kids ages 2 or under, and
* 10 µg per year of age for kids from 2 to 15 (20 µg at age 2, 30 µg at age 3, etc.)
* 150 µg for kids 15 or older
Parents were instructed to dilute the glucagon as instructed in the glucagon emergency kit, but then to use a standard U-100 insulin syringe (30, 50, or 100 units) to draw up the glucagon. Each "unit" on the U-100 insulin syringe corresponds to 10 µg of glucagon. Thus kids two or under received two "units" of glucagon, while a 10-year-old would receive 10 "units," based on the dosing schedule above. Parents monitored blood glucose every 30 minutes. If the child hadn't improved in 30 minutes, the dose was doubled and given again.
The results were excellent. Given in the doses outlined, blood sugars rose an average of 3.33-5.00 mmol/l (60-90 mg/dl) within 30 minutes and lasted for about an hour. Also, in the doses given as described, the glucagon did not cause an increase in nausea as is typical with large dose glucagon, and none of the kids vomited from the glucagon.
The team stressed that their approach is suitable for relative hypoglycemia in the face of stomach illness or lack of cooperation in eating, not unconsciousness due to severe hypoglycemia.
Reference: Mini-Dose Glucagon Rescue for Hypoglycemia in Children With Type 1 Diabetes, Diabetes Care 24:643-645, 2001. (Full text)
http://www.diabetes.ca/files/Professional%20Pub%20Archives/DiabetesQuarterly/Diabetes%20Quarterly--FINAL--Autumn2003.pdf
This site does not supply clinical treatment information or medical advice. Any advice or information you may receive through this website or our mailing lists is not guaranteed and should always be discussed with your health care provider . The editor of this site is not a medical professional. All links are provided for your convenience and further do not signify any endorsement on our behalf.
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