Lee Chung Horn
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   DIABETES MELLITUS

 

DIABETES SELF-TESTING

Simple tests you do yourself can help you care for your diabetes and feel better. All people with diabetes have to work to keep the amount of glucose (sugar) in their blood as near to normal as possible. This is called being in control. You want diabetes control because you will feel better. Also, keeping blood sugar levels near the normal range can help prevent or delay the start of such diabetes side effects as nerve, eye, kidney, and blood vessel damage.

When you learned you had diabetes, you and your health care team worked out a diabetes care plan. The plan aims to balance the foods you eat with your exercise and, possibly, diabetes pills or insulin. You can do two types of tests to help keep track of how your plan is working. These are blood glucose tests and urine ketone tests. 

Blood Sugar Monitoring Tests

Blood sugar monitoring is the main tool you have to check your diabetes control. This test tells you your blood sugar level at any one time. Keeping a log of your results is vital. When you bring this record to your doctor, you have a good picture of your body's response to your diabetes care plan. Blood sugar checks let you see what works and what doesn't. This allows you and your doctor, dietitian, or nurse educator to make needed changes.

Who Should Test?

Experts feel that anyone with diabetes can benefit from self-monitoring of blood sugar. The American Diabetes Association recommends blood glucose testing if you have diabetes and are: 

1  taking insulin or diabetes pills

2  on intensive insulin therapy

3  pregnant

4  having a hard time controlling your blood sugar levels

5  having severe low blood sugar levels

6  having ketones from high blood sugar levels

7  having low blood sugar levels without the usual warning signs

Urine Tests

Urine tests for sugar are not as accurate as blood tests. Urine testing for sugar should not be done unless, for some reason, blood testing is impossible. A urine test for ketones is another matter. This is an easy test that is very important when your diabetes is out of control or when you are sick. You can find moderate or large amounts of ketones in urine when your body is burning fat instead of glucose for fuel. This happens when there is too little insulin at work. Everyone with diabetes needs to know how to test their urine for ketones.

How Blood Tests Work

You prick your finger with a special needle, called a lancet, to get a drop of blood. There are spring-loaded lancing devices that make sticking your finger almost painless. Before sticking your finger, wash your hands with water and wipe with an alcohol swab. Prick the side of your finger by your fingernail to avoid having sore spots on the parts of your finger you use the most. 

Blood glucose meters are small computerized machines that "read" your blood sugar. In all types of meters, your blood sugar level shows up as a number on a screen (like that on your pocket calculator). Be sure your doctor or nurse educator shows you the correct way to use your meter. With all the advances in blood sugar meters, use of a meter is much better than visual checking. 

Are Meters Accurate?

Experts testing meters in the lab setting found them accurate and precise. That's the good news. The bad: meter mistakes most often come from the person doing the blood checks. For good results you need to do each step correctly. But there is an easy way to check your skill. Bring your meter to your doctor's office. Do a blood sugar check minutes before or after your blood is drawn from your vein. Compare your results with the doctor's blood results. Your meter results should not be off by more than 10 or 15 percent. 

Here are other things that can cause your meter to give a poor reading:

  a dirty meter

  a meter that's not at room temperature

  an outdated test strip

  a meter not calibrated (set up for) the current box of test strips

  a blood drop that is too small

Ask your health care team to check your testing skills at least once a year. Error can creep in over time. 

Logging Your Results

When you finish the blood sugar check, write down your results. There is more to testing than finding out a number. That's why keeping a log of your results and related events (like exercise, unusual excitement, and special meals) is so important. You and your doctor or diabetes educator can use your records to learn what your test results mean for you. This takes time. Ask your doctor or nurse if you should report test results out of a certain range at once by phone.  Keep in mind that blood sugar results often trigger strong feelings. Blood sugar numbers can leave you upset, confused, frustrated, angry, or down. It's easy to use the numbers to judge yourself. Remind yourself that your blood sugar level is a way to track how well your diabetes care plan is working. It is not a judgment of you as a person. The results may show you need a change in your diabetes plan.

Testing Your Urine for Ketones

Here's how urine tests go: 1) Get a sample of your urine in a clean container. 2) Place the test strip in the sample (you can also pass the strip through the urine stream). 3) Gently shake excess urine off the strip. 4) Wait for the test strip pad to change color. The directions will tell you how long to wait. 5) Compare the strip pad to the color chart on the test strip bottle. This gives you a range of the amount of ketones in your urine. 6) Record your results.

What do your test results mean? Small or trace amounts of ketones may mean that ketone buildup is starting. You should test again in a few hours. Moderate or large amounts are a danger sign. They upset the chemical balance of your blood and can poison the body. Never exercise when your urine tests show moderate or large amounts of ketones and your blood sugar is high. These are signs that your diabetes is out of control. Talk to your doctor at once if your urine tests show moderate or large amounts of ketones.

When to Test

Ask your doctor or nurse when you should check for ketones. You may be advised to test for ketones when:

1 your blood glucose is more than 15 mM

2 you feel nauseated, are vomiting, or have abdominal pain

3 you are sick (for example, with a cold or flu)

4 you feel tired all the time

5 you are thirsty or have a very dry mouth

6 your skin is flushed

7 you have a hard time breathing

8 your breath smells "fruity"

9 you feel confused or "in a fog"

These can be signs of high ketone levels that need your doctor's help.


 

Copyright of Lee Chung Horn Diabetes & Endocrinology 2009