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Overview
Blood glucose testing and monitoring are essential in people who have diabetes. Longer-term glucose monitoring with glycated haemoglobin (HbA1c) is used to diagnose diabetes and identify prediabetes (Diabetes.co.uk, 2019a).
Type 2 diabetes occurs when either the pancreas cannot make enough insulin or the insulin it produces does not work properly (Diabetes UK, 2023a). The body turns carbohydrates into glucose, but lack of sufficient insulin means glucose is not absorbed by the cells. Instead, it accumulates in the blood – known as hyperglycaemia.
In type 1 diabetes, the body attacks the pancreas cells, preventing them from making any insulin at all (Diabetes UK, 2023b). This, too, leads to glucose building up in the bloodstream. Alternatively, hypoglycaemia is when levels of glucose in the blood drop too low.
In the UK, almost 5 million people have diabetes. Around 90% of those have type 2 diabetes, 8% have type 1, and the remainder
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Purpose
Blood glucose levels specifically refer to the concentration of glucose in the blood. In the UK, the standard is to measure the number of glucose molecules per litre of blood (mmol/litre).
Blood glucose testing and monitoring is important for patients with diabetes for several reasons. This includes:
- to indicate the effect of medication on blood glucose levels
- to identify if blood glucose levels are rising or falling, and whether the patient needs to adjust their medication or seek medical advice
- to monitor levels over time, giving an overview of how well-managed the patient’s diabetes is
- to help educate patients on how their diet and lifestyle impacts their diabetes
- to provide insight into the effects of other factors such as stress and illness on the patient’s condition (Mathew and Tadi, 2022)
Regularly self-testing at home as required helps patients to know whether they are within their target range. Routine monitoring at
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Assessment
There are different methods of testing blood glucose, and assessing an individual’s glycaemic control.
Daily testing and monitoring
Blood glucose levels fluctuate throughout the day, in response to what and when a person eats and drinks and how active they are. Diabetes.co.uk (2022b) outlines the recommended target blood glucose ranges for people with type 1 and type 2 diabetes, and for people who do not have diabetes (Table 1).
| Table 1. Recommended target blood glucose range for people with diabetes and non-diabetics | |
| Non-diabetic | Blood glucose ranges (mmol/litre) |
| Before meals (pre-prandial) | 4.0 to 5.9 |
| 90+ minutes after meal (post-prandial) | less than 7.8 |
| Type 2 diabetes | |
| Before meals (pre-prandial) | 4.0 to 7.0 |
| 90+ minutes after meal (post-prandial) | less than 8.5 |
| Type 1 diabetes | |
| On waking | 5.0 to 7.0 |
| Before meals (pre-prandial) | 4.0 to 7.0 |
| 90+ minutes after meal (post-prandial) | 5.0 to 9.0 |
| From: Diabetes.co.uk (2022a) | |
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Equipment and procedures
Finger prick testing
A finger prick testing kit containing the following equipment:
- a blood glucose meter
- a finger prick device
- a lancing device
- a test strip
- a lancet
Step-by-step instructions
- Follow standard hand-washing procedures. Do not use wipes on the patient’s skin as the ingredients may affect the result (Diabetes UK, 2023d).
- Insert a test strip into the slot on the end of the glucose monitor.
- Remove the cap from the finger prick device and insert a new lancet. Set the device by placing the cap back on and either clicking the device or pulling the plunger. Different devices will have slightly different ways of doing this.
- Ask the patient which finger they would like to take blood from. If they experience soreness after finger pricking, avoid using the thumb or index finger especially on the dominant hand. Use a different finger each time.
- Place the finger prick
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Risks and complications
There are many known long-term complications and risks associated with both type 1 and type 2 diabetes. Similarly, short-term spikes and dips in glucose levels can lead to acute complications or illness.
There are few risks and complications of blood glucose testing and monitoring itself. The risk comes with poor glycaemic control, which is more likely if a patient does not regularly test their blood glucose levels, and if longer-term HbA1c levels are not monitored.
Risks of poor glycaemic control
In the short-term, poorly controlled diabetes can manifest in symptoms caused by blood glucose levels being too high. The main symptoms are known as the ‘four Ts’:
Other symptoms which individuals may present with include:
- thrush, or genital
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Next steps
The results of daily blood glucose monitoring and occasional HbA1c tests can be used to assess:
- how well a patient’s medication is working
- whether doses need to be reviewed
- whether the disease is progressing (indicating next-step treatments)
- the likelihood of the individual developing long-term and life-altering complications
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Resources
Diabetes.co.uk. Guide to HbA1c. 2019a. https://www.diabetes.co.uk/what-is-hba1c.html (accessed 17 January 2023)
Diabetes.co.uk. Blood sugar level ranges. 2019b. https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html (accessed 17 January 2023)
Diabetes.co.uk. Continuous glucose monitoring. 2019c. https://www.diabetes.co.uk/cgm/continuous-glucose-monitoring.html (accessed 17 January 2023)
Diabetes.co.uk. Diabetes symptoms. 2022c. https://www.diabetes.co.uk/diabetes-symptoms.html (accessed 17 January 2023)
Diabetes UK. Type 2 diabetes. 2023a. https://www.diabetes.org.uk/diabetes-the-basics/types-of-diabetes/type-2 (accessed 17 January 2023)
Diabetes UK. Type 1 diabetes. 2023b. https://www.diabetes.org.uk/diabetes-the-basics/types-of-diabetes/type-1 (accessed 17 January 2023)
Diabetes UK. Diabetes statistics. 2023c. https://www.diabetes.org.uk/professionals/position-statements-reports/statistics (accessed 17 January 2023)
Diabetes UK. Checking your blood sugar levels. 2023d. https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/testing#FP1 (accessed 17 January 2023)
Diabetes UK. What is HbA1c? 2023e. https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/hba1c (accessed 17 January 2023)
Diabetes UK. Flash glucose monitors (Freestyle Libre) and continuous glucose monitors (CGM). 2023f. https://www.diabetes.org.uk/guide-to-diabetes/diabetes-technology/flash-glucose-monitors-and-continuous-glucose-monitors (accessed 17 January 2023)
Diabetes UK. Type 1 diabetes symptoms. 2023g. https://www.diabetes.org.uk/diabetes-the-basics/types-of-diabetes/type-1/symptoms (accessed 17 January 2023)
Diabetes UK. What are the signs and symptoms of diabetes? 2023h. https://www.diabetes.org.uk/diabetes-the-basics/diabetes-symptoms (accessed 17 January 2023)
Diabetes UK. Complications of diabetes. 2023i. https://www.diabetes.org.uk/guide-to-diabetes/complications (accessed
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