 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
night-time 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
Meter Fun!
Skins can often be found to make meters and pumps a
little more fun and personal.
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
Insulin Pump Therapy
Insulin pumps are small, computerized devices that deliver specific
amounts of insulin to the wearer through tubing. This is not a closed
loop or artificial pancreas but an insulin delivery method. For a
complete listing and detailed information, please see our
Insulin Pump page.
 
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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