Glucose Monitoring

Pregestational diabetes [Type 1 and Type 2]:

If diabetes was present before pregnancy, it may be necessary to check up to 7 blood sugar levels per day until sugars are under control. For example, fasting/pre-meals, 1-hour post-meals and 2-3 morning blood sugars. Once under control, the number of blood sugar checks can go down to 4 times per day (usually pre-meal blood sugars). If pre-meal blood sugars are over 100 mg/dl, an insulin sliding scale is used to determine the dose of fast-acting insulin.

Gestational diabetes

If gestational diabetes develops, it is seldom necessary to monitor blood sugars more than 4 times per day. The best times to monitor are before eating in the morning and 1 hour after breakfast, lunch and dinner.

Monitoring should be performed daily for the first week of adoption of the diet. If blood sugars are normal (60-90 mg/dl fasting and < 120 mg/dl 1 hour after meals), monitoring can be reduced to 2 days per week. Those taking insulin to control blood sugars should continue testing every day, 4 times per day.

Keep an accurate record of all measured blood sugars and bring it to every doctor's visit. In addition, try to record everything you eat, including meals and snacks. This allows health care providers to carefully review dietary intake and make recommendations to improve blood sugar control if necessary.

There are many glucometers (blood sugar meters) available at pharmacies. Consult your physician or diabetes educator for determine which meter is right for you. Most insurance carriers cover the cost of the meter, though they don’t always cover the cost of the test strips that are needed for the glucometer to function.

For women with gestational diabetes, most high risk OB practices or Diabetes in Pregnancy Programs have "loaner programs" where glucometers can be borrowed for the term of the pregnancy. Over the past few years, there have been significant improvements in lancing devices and lancets that minimize the discomfort of finger sticks.

Several meters are now available which are approved for use with blood obtained from alternate sites such as the forearm, fleshy part of the hand, upper arm or calf. In addition, several meters can now measure the sugar level with a very small sample of blood.

Avoiding common errors

Despite technological developments that have definitely improved the process of blood glucose monitoring, false results can occur if the strips are expired or if the meter is soiled or in extreme temperature conditions.

Defective or outdated strips

• Store strips in the vial or foil wrapping they come in according to the manufacturer's guidelines. Leaving them exposed can lead to false results. All strips should have an expiration date.
• Control solution should be used on the first strip in each box to verify that the strips are accurate. Every strip is compatible with its own control solution and use the control solution as if it were a drop of blood. The acceptable range of results is printed on the vial or package of strips. If the results are out of this range, call the manufacturer's toll-free customer service number for replacements.

Soiled meter

Meters measure blood glucose in one of two ways: using color reflectance or sensor technology. With reflectance meters, the blood sugar in a drop of blood reacts with an enzyme on the strip and changes the color of the strip. The meter reads the darkness of the strip and gives a number readout of the sugar value. If the window is dirty on these meters, a false high reading can occur. Almost all the newer meters use sensor technology to measures small electrical currents produced by the chemical interaction between the glucose in the blood and the chemicals on the strip. These usually do not require cleaning.

Heat or cold

• Temperature extremes (heat and cold) can affect the accuracy of blood sugar readings. Many meters have temperature warning indicators that alert the user when the air temperature is above or below the operating range of the strips. The One Touch Ultra has the widest temperature range from 43 -110 degrees Fahrenheit.
• Check the owner's manual for a specific unit.