DIABETES AND BLOOD SUGAR MEASUREMENT: HOW TO PROCEED?

People with diabetes should regularly monitor their blood sugar. The frequency of controls is programmed and adapted according to the profile of each patient. Blood sugar can be measured using a blood test in a medical analysis laboratory: measurement of fasting blood sugar and glycated hemoglobin (HbA1c) every three months. But the patient can also measure his blood glucose level anywhere, and at any time, by using a blood glucose meter himself. This is called ASG (Glycemic Self-Monitoring).

Why monitor your blood sugar level?

A chronic disease, type 1 or type 2 diabetes can be controlled and balanced with appropriate treatment. Daily monitoring of blood sugar allows the patient to prevent glycemic imbalances, to better control his diabetes. The measurement of diabetes also makes it possible to adapt the patient's treatment, diet and physical activity.

 

What are normal blood sugar levels?

Influenced by various factors, blood sugar changes during the day. It varies mainly according to energy intake and expenditure.

 

A normal blood sugar level fluctuates between 0.80g/l and 1.10g/l on an empty stomach. Two hours after a meal, it varies between 1 and 1.4 g/l. This blood sugar level should remain stable throughout the day, even after a meal or physical exertion. A complex system, in which insulin plays a key role, regulates blood sugar. What is the maximum and minimum blood sugar level of a diabetic? Diabetes is confirmed when the blood sugar level is greater than or equal to 1.26 g/l or 7 mmol/l of fasting blood, at least twice. This is called diabetic hyperglycemia. Hypoglycaemia corresponds to a measurement of blood sugar below 0.45 g/l.

 

Whether it is type 1 or type 2 diabetes, this disease is characterized by chronic hyperglycemia. The blood contains too much sugar, its glucose level is too high. This hyperglycaemia reflects a lack of insulin or a loss of its effectiveness.

 

Control your glycemic balance

High blood sugar can cause serious complications (including tissue and cell damage). Hypoglycemia can cause discomfort or even a coma.

 

However, the effects of hyperglycemia (blood sugar level too high) or hypoglycemia (blood sugar level too low) are not always easy to perceive. Performing regular blood sugar measurements allows the patient with diabetes to maintain good blood sugar control.

 

Self-monitoring of blood glucose consists of measuring one's own blood sugar level, using a blood glucose meter. It is prescribed by the doctor, depending on the type of diabetes . Indispensable in case of type 1 diabetes, the measurement of blood sugar is sometimes recommended for patients with insulin-treated type 2 diabetes. Self-monitoring of blood sugar may also be prescribed in the case of non-insulin-treated, well-controlled type 2 diabetes.

 

So how do you perform this measurement?

 

How to measure your blood sugar level?

Self-monitoring of blood glucose is carried out using a blood glucose meter. This diabetes measuring device makes it easy to take a drop of blood and measure the patient's blood sugar level.

 

When and how often?

Depending on the patient's profile, the type of diabetes and the treatment implemented, the doctor indicates the frequency and times of his self-monitoring of blood sugar. He also explains to him how to react according to the results noted.

 

In insulin-treated diabetics, blood glucose measurements should be taken every day, several times a day. These multi-daily measurements make it possible to adapt the treatment to avoid overdose or under-dose of insulin. They are performed between 3 and 4 times a day, preferably before or after meals (for example, in the morning on an empty stomach and in the evening before dinner). If symptoms of hypoglycaemia or hyperglycaemia develop, the patient should also check their blood sugar levels. The Haute Autorité de Santé (HAS) recommends at least four tests per day for type 1 diabetes .

 

In patients with diabetes who are not treated with insulin, the measurement of blood sugar levels can generally only be carried out between 2 and 3 times a week (always respecting the doctor's prescriptions). This control allows the patient to realize very concretely the effects of the treatment or the modifications of his way of life. This helps her better understand the factors that can influence her blood sugar levels. In the event of a therapeutic change, the controls can be carried out between once and twice a day. For type 2 diabetes, the frequency of controls recommended by the High Authority for Health (HAS) depends on the type of treatment implemented.

 

What device to measure blood sugar?

The patient with diabetes can measure their blood sugar level using a blood glucose meter, or by using a continuous glucose monitoring system.

 

The blood glucose meter

It can be used on an empty stomach or for a pre or postprandial measurement. To be reimbursed by Social Security (once every 4 years), the device must be used in the context of insulin-treated diabetes or diabetic retinopathy.

 

Also known as a glucometer, this measuring device aids in the monitoring and control of diabetes. Easy to use, it provides the patient with precise information on his blood sugar level. The diabetes measuring kit works with strips or electrodes, a lancing device (for personal use) and lancets (for single use, these fine needles fit on the lancing device).

 

The blood glucose meter is used to analyze the drop of blood taken using the lancing device from the patient's fingertip (in a very fine vessel, known as the “capillary”). The capillary sample is preferably taken from the sides of the fingers: these areas are in fact less sensitive. To limit the appearance of calluses or hematomas, the patient can alternate each of the two sides of the ten fingers. Note: neither the thumb nor the index finger is used in order to preserve the sensitivity of the “clamp”.

 

Blood can be deposited on a strip: it triggers a chemical reaction and a color change proportional to the level of sugar present. The meter interprets the color and displays the patient's blood glucose value. The drop of blood can also be placed on an electrode: this triggers an electro-chemical reaction and micro-currents that the reader interprets. Day after day, the patient records his results in his blood glucose self-monitoring logbook. This notebook also makes it possible to note any deviations in diet, the patient's physical activity and the follow-up of his treatment.

 

New technologies

New technologies are developing. For example, some readers have software that allows you to download and save the results.

 

Measuring blood sugar with a smartphone is also possible. Some specific blood glucose meters can be plugged directly into a phone. Once the application has been launched and the measurement taken, it is then possible to monitor and manage the various blood sugar measurements already taken. This solution also allows the patient to adapt his insulin doses, or to share his results by e-mail (with his doctor for example).

 

Finally, continuous glucose monitoring systems (CGMs) make it possible to measure the concentration of sugar in the interstitial fluid, approximately every 10 seconds. These devices are equipped with a sensor (placed by the patient himself under his skin), a transmitter and a receiver.

 

Diabetes measurement: taking the right steps

At the beginning, the steps to take to measure your blood sugar using a blood sugar meter are explained and carried out by the doctor/care team.

For a successful and painless hair removal , it is recommended to follow the following steps:

• wash your hands with warm water and soap, then dry them;

• insert the strip into the blood glucose meter;

• changing the lancing device needle (or changing single-use lancing devices) and adjusting the depth of the lancing device;

• prick the finger (on the outer face of the last phalanx, changing the finger with each measurement) and squeeze the pulp of the finger if the droplet of blood produced is not large enough;

• take the drop of blood (on the strip) and read the blood glucose result on the meter.

 

Once used, lancets and other waste must be disposed of in specific collectors, provided free of charge. Do not hesitate to ask your pharmacist for advice.