Diagnosis 21

MEDICAL TESTS USED IN THE DIAGNOSIS OF DIABETES

Although a urine or fingerprick test can reveal a raised glucose tolerance test. Your results are assessed with
blood glucose level, you need one or more of three your symptoms. If you don’t have any symptoms but
laboratory blood tests to diagnose diabetes: the random diabetes is suspected, you need a repeat blood test
or fasting blood glucose test and, if necessary, the oral carried out on a different day.

HOW THE TEST IS CARRIED OUT WHAT THE RESULTS MEAN

A health professional tests a sample of The presence or absence of glucose in the

your urine using a dipstick that changes colour urine does not necessarily indicate or discount
according to the amount of glucose present. diabetes. If your urine contains glucose, or you
The dipstick is then compared to a colour have symptoms but no glucose, you will be
chart to determine if glucose is present, referred for further blood tests.
and, if so, its level.
Urine
test

A health professional uses a device to prick the A healthy blood glucose level is in the range
side of your fingertip and obtain a drop of blood. of 4–6 mmol/L. If your test result is above
The blood drop is put onto a testing strip already 6 mmol/L, your health professional will ask
inserted in a blood glucose meter, which provides you to have further blood tests. A fingerprick
a reading of your blood glucose level. test by itself is not enough to diagnose diabetes.

Fingerprick
test

Your health professional takes a blood sample If you have symptoms and your blood glucose
from your arm to send to a laboratory for analysis. result is above 11.1 mmol/L, you are diagnosed
This sample can be taken regardless of whether with diabetes. If you have no symptoms, or the
or not you have eaten. result is lower than this, you may have a repeat
test while fasting or be given an oral glucose
tolerance test.
Random blood
glucose test

You do not eat or drink (except water) overnight, If you have symptoms and your blood glucose
and in the morning your health professional takes result is above 7 mmol/L, you are diagnosed with
a blood sample from your arm. The sample is sent diabetes; for a diagnosis of gestational diabetes,
to a laboratory for analysis. your blood glucose level must be above 5.6 mmol/L.
If you have no symptoms, or the result is lower and
you have symptoms, you may have a repeat test or
Fasting blood be given an oral glucose tolerance test.
glucose test

You do not eat or drink (except water) overnight If your fasting blood glucose level is 7 mmol/L
and in the morning your health professional takes or higher and/or your 2-hour test result is above
a blood sample from your arm. You are then 11.1 mmol/L, you are diagnosed with diabetes,
given a glucose drink, and 2 hours later your health whether or not you have symptoms; for a diagnosis
professional takes another blood sample from of gestational diabetes, the 2-hour level must be
your arm. The samples are sent for analysis. 7.8 mmol/L or higher. This test is used when other
Oral glucose tests have been inconclusive or if you have risk
tolerance factors for diabetes.
test
 22 What is diabetes?

Preventing and
reversing diabetes
For many people with type 2 diabetes, reversal (also called remission
or suppression) of their diabetes is possible through weight loss and
increased activity. These measures can also often help to prevent
prediabetes from progressing to type 2 diabetes. Other types
of diabetes cannot yet be prevented or reversed, although careful
diabetes management can help to minimize their effects.

Prediabetes and type 2 diabetes diagnosis or, at any time, reduce or delay
In prediabetes, also called borderline the need for medication. If you do not have
diabetes, your blood glucose is raised but prediabetes or type 2 diabetes but are
not high enough to be classed as diabetes. concerned that you may develop them,
It is an indication that you are at high risk you can reduce your risk by maintaining
of developing type 2 diabetes. a healthy weight, following healthy eating
If you have prediabetes, it is possible principles, and being physically active
to prevent or delay the onset of type 2 on a regular basis.
diabetes by losing weight, if you weigh
more than the recommended healthy Other types of diabetes
weight for your height (see pp.92–93), Type 1 diabetes, MODY
and becoming more active. The same (maturity onset diabetes
measures may also help to reverse of the young), and LADA
type 2 diabetes in the early years after (latent autoimmune
diabetes in adults)
cannot yet be cured,
CHILDREN AND YOUNG PEOPLE
prevented, or reversed.
Type 1 diabetes Research is being carried
However, maintaining
out into ways of delaying the onset of
a healthy weight, eating
type 1 diabetes in younger groups at risk
healthily, and being
of developing it, but the research is still at
an early stage of development.
physically active can help
Type 2 diabetes Methods for preventing
to manage the conditions
this type of diabetes, minimizing its effects, and prevent complications.
or putting it into remission for children and
▷ Benefits of exercise
young people are the same as those for
Regular exercise can help you to
adults: weight loss and increased activity.
lose weight, prevent or reverse
Specialist help from health professionals is prediabetes or type 2 diabetes,
vital, together with emotional and practical and, for any type of diabetes, help
support for the whole family. you to manage your condition
more successfully.
 Preventing and reversing diabetes 23

If you develop gestational diabetes, it The keys to prevention or reversal

may disappear after you have given
birth, although it indicates that you are losing weight and becoming
are at high risk of developing type 2 more active
diabetes. You can help to minimize
this risk by maintaining a healthy prediabetes or type 2 diabetes, you may
weight and eating pattern. also be offered a programme* to help
you prevent or reverse your diabetes.
Practical measures
For information on measures to lose Weight-loss surgery
weight (if necessary), see pp.94–99, Also called bariatric surgery, weight-loss
and for suggestions about becoming surgery is not usually recommended for
more active, see pp.100–103. Together, diabetes unless you have type 2 diabetes,
weight loss and increased physical are very overweight, and have been unable
activity reduce the amount of internal to lose weight by any other means. There
fat around your liver and pancreas, are various procedures, but they all either
which increases the efficiency of insulin reduce the size of your stomach or
production. Reducing internal fat re-route part of your digestive tract to
also counteracts insulin resistance by bypass the stomach and/or part of the
increasing your body cells’ response to intestine. The most common method
insulin. In addition, these measures help is gastric banding, which is reversible,
to reduce health risks associated with unlike other types of bariatric surgery.
diabetes, such as heart disease, and Surgery can be effective in reversing type 2
physical actvity can help to reduce diabetes, reducing blood pressure and
stress and boost your mood. blood lipid levels (such as blood cholesterol
Preventing or reversing levels), and improving your health and
type 2 diabetes means that quality of life in the long term. However,
you have reduced your blood weight-loss surgery is not suitable for
glucose level into the non- everybody and, like all surgery, carries the
diabetes range. However, this risk of complications and adverse effects.
does not mean that you have
Oesophagus
been cured. There is the risk that
Small
your prediabetes or type 2 diabetes ◁ Gastric banding
stomach Adjustable
will return – for example, if you regain pouch In this type of bariatric
gastric band
surgery, the size
lost weight – and for this reason, you
of the stomach is
will still need regular health reviews. reduced by placing an
Losing weight and becoming more inflatable band around
active can be very challenging. You the upper part of the
will be more successful if you have stomach. The band
can be tightened by
clear, realistic goals, an action plan,
injecting liquid into it
and encouragement. Ask your health through an access
professional for personalized support to Access port port implanted just
Small
help you achieve your goals. If you have intestine under skin under the skin.
 24 What is diabetes?

What to expect when

first diagnosed
A diagnosis of diabetes can affect your life in many ways. It may
affect you emotionally and will also have practical effects on your
everyday life as you learn to manage your condition. You will have
various medical checks, meet a range of health professionals,
and receive a great deal of advice and information about
adjusting to life with diabetes.

Medical checks and treatment MEDICAL CHECKS ON DIAGNOSIS

If initial checks or symptoms indicate that you may
have diabetes, the diagnosis will need to be confirmed Height and weight measurement
to calculate your body mass
using special tests (see pp.20–21) by a doctor. If the index (see p.93).
diagnosis is confirmed, you will have additional
medical checks to assess other aspects of your
Blood pressure measurement
health, such as your eye health, heart and circulation,
and checking your heart health
and nerve function. These checks also provide a with a stethoscope
baseline for your future annual reviews, which will
include the same checks (see pp.142–143). The initial
Examination of your legs and feet
checks are also useful for detecting any health issues to check your blood circulation
that need immediate treatment or monitoring. and sensation
Along with the medical checks, you will be
prescribed initial treatment for your diabetes,
Retinal photography to check the health
either insulin or other medication. If you have of your retina (the light-sensitive layer
type 1 diabetes, you will be referred urgently to a in your eyes)
specialist clinic, where you will learn how to manage
insulin; for the first few weeks, you will also have Blood tests to check your glucose levels
frequent – possibly daily – contact with the clinic (with the HbA1c test, see p.31); blood lipids,
such as cholesterol; thyroid function; liver
staff. If you have type 2 diabetes, you will continue function; and kidney function
to attend your GP’s clinic regularly to establish the
type and amount of diabetes medication you need
and monitor your progress. If necessary, you may
also be prescribed other medication, for example, Coming to terms with
to reduce raised blood pressure.
Your initial care will also include a consultation
living with diabetes means
with a dietitian about your food in relation to your exploring your feelings as
diabetes, and with other health professionals to
provide any immediate practical advice you may
much as taking insulin or
need, such as help with blood glucose monitoring. other medication
 What to expect when first diagnosed 25

Working with health professionals attending a course, your health professional

Diabetes care is optimal when you and your health can provide your education personally or make
professionals work together as a team, with you as arrangements that are convenient for you.
the expert on your own life and health and them as
experts on the medical aspects of the condition. Emotional support
This approach is known as individualized care When you are first diagnosed with diabetes, it can
planning, and it begins right from diagnosis. take time to adjust emotionally. You will be asked
When you are first diagnosed, you will be offered about your feelings during your early consultations
a diabetes education course to learn more about the and given the chance to talk about them. This is
condition, ask questions, and meet others who are important because your feelings can influence how
also newly diagnosed. The courses are run by well you are able to manage your diabetes so that you
diabetes health professionals. The timing and length stay healthy (see pp.110–111). You may also find it
of the courses vary, but the content is similar and helpfuI to join a diabetes support group, whether you
includes information about diabetes itself, food, have diabetes yourself or are responsible for someone
treatments, and how to keep healthy. For people who has diabetes. When you are first diagnosed,
who have type 1 diabetes, carbohydrate counting trying out a local or online support group – peer
(see p.82), adjusting insulin doses (see pp.48–51), support – will help you work out whether the group
and dealing with hypoglycaemia (see pp.62–67) is useful for you. Your health professional can also
are also covered. If you have any concerns about give you information about support groups.

◁ Working in partnership
Everybody with diabetes has
individual healthcare needs and
diabetes management. Working
in partnership with your health
professionals enables your diabetes
care to be tailored to your specific
needs and preferences.
 Managing
your blood
glucose
Monitoring blood glucose
Monitoring equipment
Checking your blood glucose
What your results may mean
Medication for diabetes
Insulin treatment
Types of insulin
Insulin regimens
Adjusting insulin doses
Insulin equipment and care
Injecting insulin
Other diabetes medication
Advances in treatment
Hypoglycaemia
Recognizing hypoglycaemia
Treating hypoglycaemia
Hyperglycaemia
Recognizing and treating hyperglycaemia
 28 Managing your blood glucose

Monitoring blood glucose

Regularly monitoring the amount of glucose in your blood is a key part
of the daily care of your diabetes. The results give you information about
how your blood glucose is responding to treatment, so you can adjust it
if necessary. To manage your blood glucose effectively, it can help if you
understand what level you are aiming for and factors that can affect it.

Understanding blood glucose levels Types and aims of monitoring

Your blood glucose level is a figure that indicates There are two main types of monitoring: self checks
the concentration of glucose in your blood. The of your blood glucose level, which you do every
level is given as millimoles of glucose per litre of day, and measuring your HbA1c (glycosylated
blood (abbreviated to mmol/L). Your blood glucose haemoglobin) level, which is carried out by your
level naturally changes throughout the day. For healthcare professional at regular intervals.
people without diabetes, their body keeps the level The aim of self checks is to give you information
within a constant range, usually 4–7 mmol/L. For about the effects of the factors that can affect your
people with diabetes, their body cannot maintain blood glucose level, such a food, drink, activity, and
the glucose level effectively and the changes tend medication. If you change your diabetes treatment,
to be larger and more frequent. monitoring your blood glucose will give you vital
feedback on how well the treatment is working.
Self-checks can also tell you if your blood glucose
is low (hypoglycaemia, see pp.62–67) or raised
Glucose: over (hyperglycaemia, see pp.68–71), and can help you
7 mmol/L to manage special situations, such as illness. The
HbA1c test gives a measure of your blood glucose
High blood level over the previous 2 or 3 months.
glucose level
(hyperglycaemia)

If you change your diabetes

Glucose:
4–7 mmol/L
treatment, monitoring your
blood glucose will give you
Usual blood vital feedback on how well
glucose level
the treatment is working
Glucose: under ▷ Blood glucose checking
4 mmol/L Using a lancet to obtain a drop of blood from your finger for
checking your blood glucose level with a meter is simple to
Low blood
do and can usually be fitted into your everyday activities. This
glucose level fingerprick method provides an accurate snapshot of your
(hypoglycaemia) blood glucose level at that time.
Monitoring blood glucose 29
30 Managing your blood glucose

Recommended blood
KEY TIMES FOR
glucose levels EXTRA MONITORING
Whatever type of diabetes you have, as a Monitoring your blood glucose is always
general rule of thumb, it is recommended important, but there are certain times when
that you aim to keep your blood glucose you need to check more often.
within the range 4–9 mmol/L. This is ● During and for several hours after vigorous
or long periods of exercise.
close to the blood glucose range of a
● If you have an unpredictable working
person without diabetes (4–7 mmol/L). pattern or do shift work.
A blood glucose level that is in the
● If you change your medication and/or
recommended range will keep you insulin regimen.
feeling well and help to prevent possible ● When planning a pregnancy and during
long-term complications. Although a the pregnancy itself.
blood glucose level of 4–9 mmol/L is ● When you are ill.
a general recommendation, you and ● If you have been drinking alcohol or using
your healthcare professional may recreational drugs.
agree on different target ranges that ● During holidays and celebrations.
are appropriate for you personally. In
addition, you may be given different
recommended targets in specific and/or insulin (see pp.42–43), because
circumstances; for example, if you of the risk of hypoglycaemia with these
have difficulty recognizing a hypo treatments. In this case, typically you will
or if you are planning a pregnancy. be advised to check your blood glucose
routinely twice a day.
Frequency of checks Whatever type of diabetes you have,
If you have type 1 diabetes, you will be if you are particularly concerned about
advised to check your blood glucose hypos while you are sleeping, you may
between 4 and 10 times a day. If you be advised to check your blood glucose
have type 2 diabetes, you may not need level during the night. There are other
to check your own blood glucose levels, times and situations in which your blood
except if you are taking medication that glucose level is likely to vary or you are
includes an insulin-stimulating drug, at particular risk of a hypo and you will
such as a sulphonylurea (see pp.58–59) need to do extra checks (see box, above).

◁ Typical
recommended targets
Blood glucose levels to
aim for vary according
5–9 to your age, the type
5–7 mmol/L
4–7 mmol/L of diabetes you have
mmol/L (90 minutes
after eating) and the time of day. The
examples given here are
of typical targets for an
adult with type 1 diabetes
but your personal targets
On waking Before meals After meals may be different.
 Monitoring blood glucose 31

If you normally check your blood glucose ▷ Glycosylated haemoglobin

level, you will also need to make sure In red blood cells, glucose joins to Haemoglobin
haemoglobin to form glycosylated
you check it before you drive and at
haemoglobin, or HbA1c. The level
frequent intervals while you are driving of HbA1c indicates longer-term
(see pp.114–115). blood glucose levels.

Self-monitoring
There are various methods of checking Glucose
your own blood glucose levels. The
simplest is a urine test, in which a glucose- so it provides a picture of your average Red blood
sensitive test strip is dipped in a sample of blood glucose level over the previous cell
urine. The strip changes colour according 2 or 3 months and gives an indication
to the concentration of glucose in the urine, of how well your diabetes treatment
and the colour of the strip is compared is working. The test usually involves
against a chart to give a reading of the laboratory analysis of a blood sample
blood glucose level. This method may taken from a vein in your arm or by a
be used by healthcare professionals but portable fingerprick meter. Typically, you
home urine testing is not very accurate will be offered an HbA1c check by a
and is not generally recommended. health professional every 3 to 6 months,
The most common method for self- whether or not you self-monitor your
checking is with the fingerprick method, blood glucose levels.
in which a drop of blood is obtained by
pricking your finger with a lancet, then 70
applying the blood to a strip that is analysed
by a blood glucose meter to give a reading Above recommended level
(above 58 mmol/mol; 7.5%)
of your blood glucose level (see pp.36–37).
Other methods include using a continuous 60 7.5
blood glucose monitor, which provides

HbA1c level (per cent)

HbA1c (mmol/mol)

continuous readings of you glucose level Recommended level

(48–58 mmol/mol; 6.5–7.5%)
using a sensor under the skin (see pp.35
and 37), and flash monitoring, which 50 6.5
provides readings using a skin sensor
and separate scanner (see pp.35 and 37).

The HbA1c test 40 Below recommended level

(under 48 mmol/mol; 6.5%)
Also sometimes called the glycosylated
haemoglobin test, this test relies on the
fact that, in the blood, glucose joins
to haemoglobin (the oxygen-carrying 30
component of blood), forming a substance
△ Recommended HbA1c level
known as glycosylated haemoglobin, The recommended level of HbA1c is 48–58 mmol/mol (also
or HbA1c. The level of HbA1c is not sometimes given as 6.5–7.5%), although you and your health
significantly affected by recent food intake, professional may agree a personal target range.
 32 Managing your blood glucose

Monitoring equipment
Special equipment is available to enable you to check your blood
glucose level. The most common method is fingerprick checking.
This involves using a lancing device and lancet to obtain a drop of
blood, which is then put on a test strip that has been inserted in
a blood glucose meter. Other methods are continuous glucose
monitoring and flash monitoring, which utilize sensors in the skin.

Lancing devices and lancets To obtain a drop of blood for a glucose

A lancing device is a hand-held device check, you remove the protective end cap
containing a spring and a lancet. from the lancing device, insert a lancet,
Each lancet consists of a plastic body and adjust the depth dial to alter how
containing a needle, which has has a deep the lancet needle penetrates (see
protective cap over its end. Each lancet illustration opposite). Then you prime the
is designed to be used only once. There device, hold it against your finger, and
are different designs of lancing devices press the release button to fire the lancet.
but they all typically have the same basic Once you have completed your blood
features: a control that enables you glucose check, you remove and dispose
to alter the depth to which the lancet of the lancet in a medical sharps box.
penetrates your skin; a priming button With single-use lancing devices, typically
that compresses the spring ready for you only need to remove the cover, place
firing the lancet’s needle; and a release the device against your finger, then press
button that fires the needle. the release mechanism.

Priming button Release button Depth selector

5
7

Protective
end cap
Protective cap
Lancets
Needle Depth selector ◁ Types of lancing
and end cap devices and lancets
The various lancing devices are all
designed to enable you to obtain
Priming
button a blood sample easily and with
minimum discomfort. Not all
types of lancet fit all lancing
devices, so you need to check
Release button compatibility before use.
 Monitoring equipment 33

INSTALLING A FRESH LANCET

Different lancing devices vary in their design, features, but you should refer to the manufacturer’s instructions
and precise method of installing a fresh lancet. The general for specific information about installing a lancet for
method shown here is applicable to many types of lancet, your particular device.

Remove the end Take a fesh lancet Twist off the lancet’s Carefully replace
1 cap from the lancing
2 and insert it into the
3 protective cap to
4 the end cap of the
device. This will expose exposed socket of the expose the needle. Take lancing device and twist
the socket into which lancing device. Make sure care not to contaminate the depth selector to
you will insert a fresh you push the lancet in as the needle by allowing it adjust how deep the
lancet. far as it will go. to touch anything. needle will penetrate.

Test strips into a reading of your blood glucose

A glucose test strip is inserted into a level. Test strips are available in pots of
blood glucose meter and then a drop of 25 or 50 strips, or individually packed.
blood is applied to the end of the strip. A The strip you use must be new and
chemical in the strip reacts with glucose within its expiry date. If you use a strip
to produce a small electric current, which from a pot, replace the top immediately
is detected by the meter and converted to protect the remaining strips.

▽ Blood glucose test strips

Test strips are small, disposable pieces of SAFE DISPOSAL
plastic containing a chemical that reacts with OF USED EQUIPMENT
glucose in blood. Most strips are designed to It is important that your used lancets and
be used by one type of meter. test strips are disposed of safely. They
should be put in a medical sharps box.
A sharps box should also be used for
disposable needles and syringes. Once
an item has been put in the box, do not
try to take it out again. The box should
be kept in a safe place, out of the sight
and reach of children. When full, the
box should be sealed and disposed of
according to the arrangements for your
particular area. Your health professionals
will be able to advise you about these.
34 Managing your blood glucose

Blood glucose meters a range of functions and features.You will

These are small, battery-operated be given one by your health professional
devices that measure and display the if they advise you to check your blood
level of glucose in a small sample of glucose level, or you can choose to buy
blood on the test strip (see Checking one, or a spare one.
your blood glucose, pp.36–37). The From time to time, it is advisable to
display appears in a few seconds. You check the accuracy of your meter. This
can then record the result, add it to the simply involves using a control solution
meter memory, or download it. There are with a known level of glucose instead
many different meters available, with of a blood sample.

CHOOSING THE RIGHT METER

There are a number of aspects to consider below, you might also want to consider the
when you are working out which is the right cost and/or availability of the test strips a
meter for you. As well as the points listed particular meter uses.

SIZE A compact meter is more convenient to carry, but if you have a condition
that affects your dexterity, such as arthritis, you may find a larger meter
easier to use.

SIZE OF BLOOD The amount of blood you need to put on a test strip to obtain an accurate
SAMPLE reading can vary according to the equipment you use. If you find it difficult to
obtain blood, it may help to choose a meter that needs only a small sample.

DISPLAY A meter with a large display may be easier to read. Some meters show
the reading on its own, others display additonal information as well. More
sophisticated meters enable you to customize the display.

MEMORY Meters vary in the number of readings they can store. A large memory is useful
if you cannot record or download the readings.

DOWNLOADING Some meters allow you to download your readings and analyse them on a
computer or smartphone. This enables you to see your blood glucose levels
over a period in graph or table form.

AVERAGES Many meters can give you an average of your readings over the past week
or longer.

TIMING Meters vary in how quickly they display readings. A meter with a shorter
analysis time may make it easier for you to do a blood glucose check when
you are busy.

ADVANCED Some meters can measure both blood glucose and blood ketones. Others
FEATURES can hold multiple test strips so you do not need to insert one every time
you use it. Some high-tech meters contain built-in software that provides
various analysis and/or display options.
 Monitoring equipment 35

▷ Varieties of meters Test strip

Test strip
Blood glucose meters are available
Strip holder
in various sizes and shapes and Strip holder
5:00 PM
with different added features to suit
individual requirements. They all
07:32
5.8 Information

4.6
Information mmol/L
display
have to meet minimum standards display
mmol/L
for accuracy. Like all electronic
Scroll button
devices, they should be kept clean Power and
and dry. Most types use standard set-up button
Power and
batteries, although some models set-up button
are rechargeable.

Continuous glucose monitors Flash monitors

A CGM consists of a sensor, transmitter, Similar to a continuous glucose monitor,
and receiver (a hand-held reader or a flash monitor consists of a sensor fitted
a combined reader and insulin pump). into the skin and a separate scanner that
The sensor, which is fitted into the skin, displays your blood glucose reading.
measures glucose in the fluid around As with a CGM, the sensor of a flash
the cells below your skin (known as monitor measures the glucose level in
interstitial fluid). The glucose level in this interstitial fluid, which is then converted
fluid mirrors the level in your blood but into a reading of your blood glucose
there might be a short time lag before level. Instead of a scanner, you can also
the CGM reading accurately reflects use a compatible smartphone that has
your blood glucose level. the correct app.

Reader and Result

Glucose Cells insulin pump Glucose Cells displayed

Skin surface Skin

surface Scanner
Transmitter
22:23
07:32 13 days

5.8 mmol/L Sensor 6. 2

Data
Bolus 3450 u
mmol/L
Total 5000 u
Stop Bolus Basal

sent

Sensor Sensor
filament
Sensor filament
Scanner reads
Blood Interstitial Blood Interstitial data from
capillary fluid capillary fluid sensor

△ How a continuous glucose monitor works △ How a flash monitor works

A sensor detects glucose in interstitial fluid. A A flash monitor works in a similar way to a
transmitter automatically sends data about the continuous glucose monitor. However, a flash
glucose level to a reader, which displays your monitor does not have a transmitter. You need
blood glucose level, or to a combined reader and to scan the sensor to obtain a reading of your
pump, which can also manage your insulin dose. blood glucose level.
36 Managing your blood glucose

Checking your blood glucose

There are various ways of checking your blood glucose. The
commonly used fingerprick method gives an accurate “snapshot”
reading of your glucose level. Other checking options are to use
a flash monitor or a continuous glucose monitor.

Fingerprick method will pierce your skin. The second item is

This procedure gives you an immediate a blood glucose meter. The third is a set
reading of your blood glucose level. For of test strips. You insert one end of a
fingerprick readings, you need three strip into the meter and collect a drop of
items of equipment. The first is a lancing your blood on the other end. The meter
device for pricking your finger to get a analyses the information from the blood
drop of blood. This device fires a small on the strip to produce a reading of your
needle, known as a lancet, into your skin; blood glucose level. You also need a
you can set the depth to which the lancet sharps bin to dispose of used lancets.

DOING A FINGERPRICK CHECK

The usual site for taking a blood sample is the side of your take blood from these sites.) Take care to follow the
fingertip, not too close to the nail. (Less commonly, you manufacturer’s instructions on how to use your meter
may need to take blood from your forearm, the palm of your correctly. It may help to rub your hand from the palm
hand, or your abdomen, if your equipment is designed to towards your fingers to get the blood flowing.

Wash and dry your Take a fresh test Press the tip of the
1 hands. With a fresh
2 strip from its
3 lancing device on the
4 Once you have
obtained a large
lancet in your lancing container. Switch on side of your finger. Press enough drop of blood,
device, turn the device’s your blood glucose the button to fire the apply the blood to the
dial to your preferred meter or insert the test lancet. Lift the device and end of the test strip.
depth level. Low numbers strip into the meter to wait a few seconds for a After a short period,
indicate a shallow depth; switch it on, depending drop of blood to appear. the meter will display
higher numbers mean on the manufacturer’s (Pressing the base of a reading of your
that the lancet will instructions for your your finger can help the blood glucose level
penetrate deeper. specific meter. blood flow.) on its screen.
 Checking your blood glucose 37

△ Using a continuous glucose monitor △ Using a flash monitor

Attach the sensor and transmitter to your skin. To obtain a reading, hold your flash reader or
These continually send blood glucose data to a smartphone (if it has the correct app) over the
separate monitor, which displays your readings. sensor. The data will appear on the screen.

Continuous glucose monitoring Flash monitoring

A CGM measures your glucose level Like a CGM, a flash monitor measures
continually, and you can choose to see your blood glucose continually. However,
your readings immediately (real-time CGM) unlike with a CGM, you have to manually
or can download a set of readings every scan the sensor to see your readings.
day (retrospective CGM). A CGM can also As well as your blood glucose level, the
be set up to alert you if your blood glucose display also has an arrow to indicate
becomes too high or low. Because a CGM whether your blood glucose level is
measures glucose in the interstitial fluid stable, rising, or falling. Flash monitors
(see p.35), you still need to do a fingerprick also have a memory feature, but they
check if you need immediate information do not have an alarm that will alert you
about your blood glucose level. You will if your blood glucose level falls outside
also need to do one or two fingerprick your recommended range. It is also not
checks a day to ensure the CGM readings possible to link them to an insulin pump.
remain accurate. Some CGMs can also As with CGMs, you will need to do a
link to an insulin pump, to manage your fingerprick check from time to time to
insulin dose (see pp.54–55). check the accuracy of readings.

RECORDING LEVELS
It is useful to keep a record of your glucose storage and analysis on a smartphone,
readings so that you can see changes over tablet, or computer. Also keep notes
time. You can record the figures in a written about your food, medication doses, and
diary, but many blood glucose monitoring activities so that you can relate these to
systems enble you to upload results for your blood glucose readings.
 38 Managing your blood glucose

What your results may mean

Examining your blood glucose results over a period of days
or weeks can give you vital information about how well you
are managing your blood glucose level and what action,
if any, you need to take in response.

Responding to results 4–9 millimoles per litre (mmol/L). If your

It is better to look for patterns in your results are rarely or never in this range or
blood glucose readings than to focus on constantly fluctuate, try taking corrective
the occasional high or low reading. If you action, such as changing your food,
can view the figures as a graph or table, activity level, or medication dose. If
it is easier to spot trends: for example, these measures don’t work, speak to
whether your reading tends to be high your health professional as you may
or low at a particular time of day. The need a change in your medication
ideal range for your blood glucose is and/or insulin regimen.

▷ Checking results Indictator Arrow indicating

Some monitors can showing if latest Monitor whether your blood
reading was in Glucose glucose is falling,
display results as a target range rising, or stable
graph or chart, or

6.0
can upload them to
a computer or mobile In Range mmol Latest blood
device, such as a Time of last
L glucose
reading reading
smartphone, to enable 10m ago
you to see the results Tinted area
graphically and indicates
12
spot trends in your target blood
Upper limit of glucose range
glucose readings. target blood 9
glucose range
6

19:00 Time of day

3 16:00
0 13:30
:00 12:3
Lower limit of 6:00 9:00 11
gs/Day

erview
target blood 20 Readin
glucose range
9 0 Day Ov
High
Graph displaying Within ta
rget rang
e
proportion of time blood Low
glucose levels were vents
below, within, or above Recent Eeek This Month
your target range This W Record of
Today l/L
6.0 mmo most recent
19:30 7.9 mmo
l/L
blood glucose
19:00 4.8 mm o l/L levels today
Time of most 18:30 o l/L
recent readings 4.0 mm
taken today 18:00 4.0 mm o l/L
17:30
 What your results may mean 39

Higher blood glucose readings Lower blood glucose readings

In practice, a single raised reading with Blood glucose levels below 4 mmol/L
no obvious cause happens from time indicate hypoglycaemia and need to be
to time and does not need any action. treated immediately (see pp.66–67). If
However, if your readings are constantly your levels often fall below 4 mmol/L, this
raised over a day or more, you need to can reduce your awareness of the signs
find the cause and take appropriate of a hypo. If you have had a hypo, work
action. For example, if stress or illness out the cause and then closely monitor
raises your blood glucose for more than your blood glucose levels to enable you
one or two days, you can temporarily to plan ahead to help maintain your
increase your medication. If you have put target blood glucose levels.
on weight, you may need to increase
your medication to counteract the insulin
resistance this causes. Subsequent blood Rather than focusing on the
glucose levels will show how successful
your actions have been. (For more about
occasional high or low result,
hyperglycaemia, see pp.68–69.) look for patterns
COMMON CAUSES OF HIGHS AND LOWS

An occasional out-of-range blood glucose level does promptly). However, if you notice a pattern of highs
not indicate that you need to make changes (although or lows, or constant fluctuations, finding out why
a low blood glucose level should always be treated can help you take corrective action.

HIGHER READINGS LOWER READINGS

Having more food than usual or a different type of food. Having less food than usual, or taking your insulin
(A specific food may be a cause if it’s associated with high and/or medication and then being unable to eat at the
readings on several occasions.) planned time.

Being less physically active than usual. Being more physically active than usual.

Illness can cause a high blood glucose reading, Stress can make your blood glucose level fall if you respond
as can stress hormones. to it by using up more energy or eating less than usual.

Forgetting to take your medication or your insulin Taking an extra dose of medication, injecting more than your
or taking an insufficient dose. usual dose of insulin, or being on too high a dose of medication
or insulin.

Putting on weight. Losing weight.

Special circumstances, such as having a hypo earlier in Special circumstances, such as drinking a lot of alcohol without
the day, which you treated with glucose (when you are hypo, compensating by eating carbohydrate-containing food at the
your liver also converts glycogen into glucose and releases the same time or reducing your dosage of medication.
glucose into your bloodstream).
40 Managing your blood glucose