TIPS FOR EFFECTIVE SELF-MONITORING OF BLOOD GLUCOSE
Blood glucose meters give very accurate results but only when the proper technique is used. All meters come with clear directions but these instructions may still be confusing for some patients. It is important to review the instructions in detail with your patients including demonstrating the use of the meter to them and, ideally having the patient demonstrate the use of the meter back to you. Finally, you can encourage them to follow up when they get home by re-reviewing the manufacturers directions before using the meter.
Topics to include when Training a Patient to use a Blood Glucose Meter
TOPIC
Thorough review of meter operation: buttons, battery, cleaning, etc.
NOTES
Meters should be kept clean and not exposed to extreme temperatures. Strips must not be left open to the air. Strips that are foilwrapped can be used until the expiry date on the package, provided each strip is opened only at the time of use. Strips in a vial must be left in the vial with the top closed until they are used. Most strips in a vial will expire 3-6 months after the container is opened. Patients should be instructed to mark the date it was opened on the vial, and not to use the strips beyond that date. Some strips in vials can be used until the expiry dates. Check each manufacturer for differences. Patients should be instructed to ensure that their hands are clean prior to handling the test strips or obtaining a blood sample. Some people prefer to use alcohol swab to clean the testing site, especially if they are on the go. However, the use of an alcohol swab is not necessary if the area is well washed. Insufficient sample volume and poor blood collection technique are the most common types of user errors. Review possible testing sites including whether or not alternate site testing is appropriate. A sufficient drop of blood, as defined in the instructions for the meter, must be obtained for accurate checking. Some meters have technology that enables the meter to detect when the strip does not have enough blood on it. In these cases, an error message will be given. If the meter
Proper storage and handling of test strips
Personal factors to consider before use
Procedure for obtaining blood sample
does not have this feature, it may still display result but it may be inaccurate. Patients should be trained on the proper use of the lancing device as well as the meter. See the section on Obtaining a drop of blood following this table.
Recording results: written log, software
Review the meters memory and reporting features with the patient. It may be beneficial for some patients to retain a written log of their results. These logs often make it easier to quickly review the results for an extended period of time and also allow for more detailed notations. A written log would also be important if the patient intended to use more than one meter to track their blood glucose readings (i.e., one at home, one at the office) The meters quality control procedures should be reviewed with the patient, including any reference to coding or regular calibration that may be necessary.
Quality control, maintenance
Obtaining a drop of blood
People who are checking their own blood glucose levels will need a lancing device and lancets to get a drop of blood. Lancing devices basically use a spring-loaded needle and are intended for single-person use. Lancets should be used only one time but in practice some people will use them more often to save on the expense. Patients should be advised against this practice as repeated use will cause the lancets to become dull and result in more painful lancing.9 When using the Lancing Device:
Make sure to choose the appropriate cap, if applicable. Many lancing devices come with different caps for getting blood samples from alternate sites or one that can be adjusted for different depths of injection. If fingertip testing, place the device at the outer part of the fingertip not in the middle of the finger. This site is less painful. To encourage blood flow once the skin is pierced, squeeze the finger starting at the base of the finger and GENTLY pushing the blood to the tip of the finger. If the finger is squeezed too firmly at the tip, the sample will contain fluid other than blood and may provide an inaccurate reading. Encourage patients to use either special sharps containers available at the pharmacy or, if permitted in your area, tin or plastic containers to dispose of used lancets. These should be containers that can be sealed before disposal.
KEY POINT: Obtaining an adequate drop of blood is very important in getting
an accurate blood glucose result. Proper technique will reduce the discomfort that the person feels when they obtain a drop of blood.
ACTIVITY HOW YOU CAN HELP
Make a list of all the lancing devices available and the lancets that will fit each device. Most lancets will fit more than one device. This will help if the pharmacy doesnt carry the particular device or lancets a patient is looking for. Some lancets are coloured to help patients remember to change their lancet
Verifying SMBG performance and results
Variability exists between blood glucose results obtained using self-monitoring devices and laboratory testing of plasma glucose. In order to ensure accuracy of meter readings, meter results should be compared with laboratory measurement of plasma glucose at least annually, as well as when indicators of glycemic control do not match meter readings. In addition, periodic review of correct monitoring technique may improve the accuracy of SMBG results.5
KEY POINT: As mentioned previously, the action a person takes based on their
blood glucose results is more important that the test result itself. Beyond learning about the mechanics of the meter and how to use it, it is even more important for the pharmacist to follow that with a discussion on how to interpret the results and identify any patterns that may present as well as how to make appropriate adjustments to diet, activity or treatment regimen based on these blood glucose patterns.
PRACTICE TIP HOW YOU CAN HELP
It is not only important to talk to patients when they are first diagnosed and/or when they first purchase a blood glucose meter. When patients return to the pharmacy to refresh their supplies (strips, lancets, etc.), take a moment to ask them how it is going. This can help you assess whether or not they need to be referred to the pharmacist for further follow-up or education.
