Health Tips

Malaysia is one of the ‘sweetest’ countries in the world — 1 in 5 adults in Malaysia have diabetes, according to the findings of National Health and Morbidity Survey 2019. If you are a diabetes patient, you have an important role in your own medical care, and monitoring your blood glucose (sugar) level is a key part of this.

Photo by Kate on Unsplash

What’s self-monitoring blood glucose?

If you have diabetes, your health care provider will periodically order a blood test to check your current blood glucose levels and glycated hemoglobin (HbA1C). The HbA1C test gives an overall sense of how blood glucose levels are controlled since it measures your average blood glucose level of the past 3 months. 

However, in order to most effectively manage your diabetes and adjust your treatment approach as needed, you will also need to check your own blood glucose levels on a daily basis, and this approach is known as self-monitoring of blood glucose (SMBG). 

Self-monitoring of blood glucose (SMBG) is an important component of modern therapy for diabetes. SMBG has been recommended for people with diabetes and their health care professionals in order to achieve two important goals:

• a specific level of blood sugar control 

• to prevent hypoglycemia - we will get into hypoglycemia in a minute.

SMBG enables the diabetes patient to collect detailed information about blood sugar levels at many time points to enable maintenance of a more constant blood sugar level by more medical treatment. It can be used to aid in the adjustment of a therapeutic regimen (usually the amount of insulin to be injected) in response to blood sugar values and to help patients adjust their dietary intake, physical activity, and insulin doses to improve blood sugar control on a day-to-day basis.

Essentially, SMBG gives feedback to the diabetes patients and their healthcare provider on how their diabetes treatments go. 

Specific level of blood sugar control

Every diabetes patient has a target blood sugar level range that they should achieve as much as possible. Typically, a person should achieve HbA1c reading of less than 7.0%, and blood sugar levels of between 4.4 -7.0 mmol/L before meals and 4.4-8 mmol/L after meals. The target range may vary from individual to individual depending on age, risk of hypoglycemia and other medical conditions a person has.

The exact schedule and frequency of testing blood sugar may also be different. For example, for diabetic patients who don’t require any medical treatment and only through diet modification are advised to carry out SMBG before and after breakfast, after lunch and before going to bed. Whereas for diabetes patients who receive insulin treatment are advised to check their blood sugar before and after every meal, as well as before going to bed.

If you have diabetes, clarify with your healthcare provider on how often and the timing of checking your blood sugar level, as well as the target range for your blood sugar level.

Prevent hypoglycemia

Hypoglycemia is a condition in which a person’s blood sugar level is lower than normal. As a result, the person may experience the following:

Image credit to https://www.endocrineweb.com/conditions/hypoglycemia/hypoglycemia-overview

Hypoglycemia is especially a common problem for diabetes patients who inject insulin on a daily basis. In very rare cases,hypoglycemia can even lead to death.

Nonetheless, signs of hypoglycemia can be difficult to detect, and may be confused for other conditions. If you have diabetes, carrying out SMBG on a daily basis allows you to better grasp your blood sugar level and can respond accordingly if you find out your blood sugar level is too low. Taking a sweet drink or a tablespoon of sugar should resolve any hypoglycemia symptoms immediately. Nonetheless, if you keep experiencing hypoglycemia throughout your diabetes treatment, you should discuss with your healthcare professional and tries to address the root cause of your hypoglycemia, rather than taking sweet foods every time you experience low blood sugar level.

How to check your blood sugar level?

To carry out SMBG, you would need the following:

• A blood glucose meter, i.e. a machine that detects the blood sugar level in your blood. The machine usually comes with its own corresponding test strips and/or lancet.

• A lancet, a small medical device that pierces your fingertips for a tiny amount of blood. These blood are being put onto the test strip, and the test strip is then inserted into the blood glucose meter for reading.

• Alcohol swab - to clean your fingertip before piercing for blood.

• A thick container to put the used lancets. You may use a milo tin or detergent bottle. The lancets should not be thrown alongside with your household trash to prevent it from hurting people or animals.

Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436., CC BY 3.0 , via Wikimedia Commons

Here are the general steps of carrying out SMBG. However, because the instructions can vary between devices, it's best to check the package insert for your glucose meter or talk with your healthcare provider. 

1. Wash hands with soap and warm water, then dry.

2. Prepare the lancing device by inserting a fresh lancet. Lancets that are used more than once are not as sharp as a new lancet and can cause more pain and injury to the skin.

3. Prepare the blood glucose meter and test strip (the exact instructions for this depend upon the type of glucose meter used).

4. Use the lancet to obtain a small drop of blood from your fingertip. 

5. If you have difficulty getting a good drop of blood from your fingertip, try rinsing your fingers with warm water and shaking your hand below your waist. This can help get the blood flowing.

6. Apply the blood drop to the test strip in the blood glucose meter. The results will be displayed on the meter after several seconds.

7. Dispose of the used lancet in a container designed for sharps (not in household trash).

David-i98, CC BY-SA 3.0 , via Wikimedia Commons

It's important to never share monitoring equipment or fingerstick devices, as this could lead to infection.

A word from Doc2Us

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References

1. Standards of Medical Care in Diabetes--2013. Diabetes Care. 2012;36(Supplement_1):S11-S66.

2. Diabetes UK - Self Monitoring of Blood Glucose (SMBG)

3. UpToDate - Patient education: Blood glucose monitoring in diabetes (Beyond the Basics)

4. Ministry of Health Malaysia - CPG Management of Type 2 Diabetes Mellitus 2020

Cover image credit: Photo by Kate on Unsplash

Written by

Ms Joyce Toh