Sulfia Jabbar P - Diabetes Educator – Endocrinology, Aster Medcity, Kochi
Posted on Thursday, July 12, 2018
This fictional story seeks to answer the most frequently asked questions and doubts regarding the purchase, use and maintenance of glucose meters. A Diabetes educator is a health professional who educates about Diabetes prevention, prediabetes and Diabetes management. Every person with Diabetes ought to consult a Diabetes educator who can guide about self-management to manage blood sugar levels, avoid complications related to Diabetes and optimise health outcomes.
Basics of glucose meters
An elderly man of around 70 years and his wife consulted Ms Pooja, a Diabetes Educator. Ms Pooja asked them to take a seat. After being seated the gentleman said, “I am Rao and this is my wife, Lakshmi. I have Diabetes and we have been consulting the doctor to manage my blood sugar. I have consulted an endocrinologist today. He advised me to buy a glucose meter to check my sugar levels at home. I have never used it before. Could you guide us to know more about it?” He took out a glucose meter pack from his bag and kept it on the table. They were worried about using it.
With a smile Pooja said, “Don’t worry. It is very simple. I can demonstrate it for you.” He gave the glucose meter pack to her. Pooja took out the glucose meter from the pack and explained, “There are many types of glucose meters available in the market. A person with Diabetes can opt one according to their choice. Some glucose meters are very simple. They provide the blood sugar value but don’t have the memory. Some other glucose meters have inbuilt memory which can store previous blood sugar values. Some of the latest glucose meters store results which can be downloaded later from the glucose meter. This presents a clear picture for the doctor about your blood sugar values. Some other glucose meters also have Bluetooth where your sugar levels can be sent to your doctor via a text or an email.”
Importance of home testing
“Why should we check the blood sugar levels at home?” asked his wife. “Blood sugar level keeps on fluctuating even for a normal person. When you have Diabetes and are using insulin or tablets to control it, there are chances that you may have low sugar levels as well as high blood sugar levels on the same day. This is clear only when we check the blood sugar level. So it is advisable to check blood sugars to have a better understanding of your blood sugar levels and to keep it under control, especially if you are injecting insulin or taking tablets. They may cause low blood sugar levels or hypoglycaemia. It will be difficult for you to depend on a pathology laboratory to check the sugar levels several times a day and you will have to wait for your results too. If the sugar level goes low below 70 mg/dL, you may have strange feelings like dizziness, sweating, tremor, palpitations, etc. This condition is known as hypoglycaemia. During this time, it will be very difficult to approach a lab to confirm whether you have hypoglycaemia. That’s when a glucose meter becomes handy.”
Glucose meter explained
“Will you be able to explain more about a glucose meter to us?” asked Mr Rao. “With pleasure!” she said and explained, “Glucose meter is a small device that helps you to check your blood sugar levels within seconds, from a single drop of blood. It works with the help of a battery. It needs only a small drop of blood to get the result. The blood can be drawn with the help of a lancet from your fingers. Lancets and lancing device that are available with the glucose meter helps you to make a wound with a painless prick.”
“Is it painless?” asked Mrs Lakshmi. “Indeed, it is painless when the prick with the lancet is made on the sides of the finger. The tip of the finger is very sensitive to pain. Hence you may prick on the sides of your finger with the lancet provided,” told Pooja. “It is interesting. Please give us more details”, said Mr. Rao.
Pooja took out the glucose meter, turned it upside down and opened the battery case. Then she told, “As I told earlier, glucose meter works on a battery. On the other side you can see the display screen. Next, we need to set up the date and time.” She sets up the date and time of the glucose meter. “How do we know the battery is working?” asked Mrs Lakshmi. “When the battery is weak, an unusual symbol or icon, usually a plus and a minus sign together will appear on the screen. You can use the user manual available with the pack to know what the symbol represents. Setting up time and date will get stored with the blood sugar values that are stored in the memory when we use the glucose meter. These data are helpful for future reference. Once the setup is complete, glucose meter is ready for use,” told Pooja.
She took out the strip case from the pack and showed it to Mr Rao and told, “These are the test strips. Some glucose meters may have code chip available with each pack, which needs to be inserted to the glucose meter before using that particular pack of strips. Once the chip is inserted, the glucose meter will display a number which you may find on your strip case. Now a days, code-less glucose meters are also available. Strip for each glucose meter works only in that particular glucose meter. When you buy strips, make sure you buy the correct strips. Some of the companies may have different models for their glucose meter and each glucose meter has specific strips. Strips are available in two forms, either as a foil pack or as a container pack. If it is available as a container pack, you need to be a little careful in handling the tests strips. Make sure you don’t touch any other strips and to close the container immediately after taking out the test strip. This is to prevent damage to the rest of the strips and to prevent displaying wrong results.”
Mr Rao and his wife were eagerly watching each and every step of demonstration when Pooja continued, “Next we need to insert the strip into the glucose meter,” she told by inserting a strip into the glucose meter and continued, “When you insert the strip, the glucose meter switches on, and after a few seconds it will show a drop icon which indicates that the glucose meter is ready for the test. When you insert the strip, make sure that you insert it properly. In the other end of the test strip, you can find an area where we have to apply the blood. Make sure that you are not touching this area while handling the strips. The latest glucose meters just draw the blood with the help of capillary actionwhereas in others, a drop of blood is required to be applied to the area provided in the glucose meter.”
Using a glucose meter
Ms Pooja asked, “Shall we try testing your blood sugar with this glucose meter now?”
Mrs Lakshmi was very happy and asked her husband to do a trial testing in front of the Diabetes educator. Then Pooja told, “Please wash your hands and pat them dry with a clean towel. Any food particle or dirt present on your fingers may give false blood results.” Mr Rao cleaned his hands. Pooja took out the lancing device and demonstrated how to insert the needles. She showed them the numbers on the lancing device and told that by selecting these numbers they can adjust the length of the needle. She told them that the smaller numbers 1 or 2 in the device are usually used for children and the other numbers for adults. Some people with Diabetes have thick skin on their fingers and they can adjust the length of the needle accordingly by selecting a higher number. Others may use the middle number to lessen the pain during pricking.
Pooja massaged Mr Rao’s finger and then cleaned the finger with an alcohol swab and waited till dry and then pricked with the lancet and demonstrated the testing with the glucose meter. “Oh! It is really painless!” exclaimed Mr Rao. Mrs Lakshmi was very happy that her husband wasn’t hurt due to pricking. They were eagerly looking at the display screen to know his blood sugar value. glucose meter showed it as 192 mg/dL. “Will this be accurate?” asked Mr Rao. “There will be a deviation of ± 20 per cent in the blood sugar result from a glucose meter which is acceptable”, told Pooja, “In a lab, the blood is drawn from a vein and the components of blood like RBCs, WBCs and platelets are removed with the help of a centrifuge and then the sugar level is measured in the serum of the blood. But in a glucose meter, the blood is drawn from the finger. The blood we get from the finger is the capillary blood. The whole blood is used here.”
“Our doctor told us to check the sugar level before and after a meal. He said checking blood sugar levels multiple times a day will help to us to know more about it and also help us to know which type of food increases the blood sugar too,” said Mrs Lakshmi.
“True, if you need to check blood glucose level multiple times a day, a glucose meter will help. This will help you to know the range of fluctuation. Moreover, there are some fruits or foods about which the people are doubtful whether it will increase the blood sugar. Checking blood sugar levels two hours after having such foods or fruits will let you know whether that particular foods or fruit increases the blood sugar level,” said Pooja.
“That means a glucose meter can help you to make a right choice of your food, right?” asked Mrs Lakshmi. “Correct! You can also check the blood sugar level if you have feelings of low sugar or hypoglycaemia. When you have a feeling of hypoglycaemia, no one will be able to go to a pathology laboratory to test the blood sugar level at that time to know how low it is. Hence it is always advisable for a person with Diabetes to buy a glucose meter to know about his/her blood sugar trend. Moreover, it is advisable to calibrate the glucose meter with test solution. At times, you may need to cross check the glucose meter results with the pathology laboratory values and if the blood sugar values show wide variation, you can contact the toll free number in the instruction manual or booklet provided with the glucose meter pack for the calibration. Many people with Diabetes who don’t know this information usually keep the glucose meter aside without using.”
“That means this instruction manual should not be thrown away,” told Mrs Lakshmi. “Yes, keep it safe. It also helps you to find the details regarding the error displayed by your glucose meter at times,” told Pooja. “Error, what sort of errors?” asked Mr Rao. “The glucose meter may display Er 1, Er 2, etc. indicating some messages which you may find in your instruction manual. It can be an expired strip, strip not inserted properly, used strip, etc. At times you may find ‘Hi’ or ‘Lo’ displayed on the screen for your glucose meter which indicates very high and very low blood sugar levels. Instructions pertaining to all these messages can be found in the instruction manual or booklet available with the glucose meter,” Pooja explained.
“From where can we buy the strips, once the strips got over?” asked Mr Rao. “It is always advisable to buy glucose meter from your locality. Then it will be easy for you to get the strips or you will have to buy common glucose meters available in the market as their strips are easily available. You can also contact the toll free number to know about the availability of the test strips too,” said Pooja.
“Who all can use a glucose meter?”asked Mrs Lakshmi. “Children, adults, pregnant ladies - anyone can use a glucose meter. But make sure that you are using a sterile lancet for pricking,”told Pooja.
“Only few lancets are available with the pack. What should we do after it is finished?” asked Mr Rao.
“Lancets are available in a pack of 100. The customer care executive will help you get it or you may buy it online” told Pooja repacking the glucose meter in its case. She replied, “Now you can carry this glucose meter with you and check your blood sugar levels whenever or wherever you are.”
Mr Rao and his wife were very happy with the demonstration, before leaving they just turned and said, “Thank you very much, Ms Pooja!” “It’s my pleasure to help you sir!” replied Pooja.
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