Goal/Objective: To establish the habit of using your blood glucose meter daily.
Time Frame: Until you have reversed your blood sugar numbers to non-diabetic normal (70-99 mg/dL or 3.8-5.6 mmol/l) or to whatever your personal goal is.
Additional Information: See article titled “Blood Glucose” in “Diabetes Basics.”
Mastering use of your glucose meter is perhaps the one most important habit you can establish! When I was first prescribed a meter, my doctor ordered enough test strips for me to test three times a day. Typically, this included fasting blood glucose, which is the first thing you do after you wake up and do nothing else except go to the bathroom and wash your hands. Once I got on insulin, it was also important for me to check my blood glucose just before bedtime. I used the third test strip at a random time during the day, pre-meal or post-meal.
Most of us get our diabetes testing supplies by prescription from a physician supported by our health care insurance provider. We take our prescription to the pharmacy and usually pay a co-pay for the supplies we need. Some older patients have found that Medicare coverage provides testing supplies with $0 co-pay. The Northern California Kaiser Permanente Health Plan (at the time of this writing) covers home blood glucose meters, test strips, lancets, lancing devices, and control solutions.
If you do not have health care insurance coverage, or if you want more testing supplies than allowed by your healthcare coverage, you may find it convenient to have a cost-effective meter just for “eating to your meter ” testing. You do not need a prescription to purchase a blood glucose meter. Some of our group members have found the ReliOn (brand) meter and test strips to be suitable, and they are available at Walmart or on Amazon. Check current pricing and availability online.
Blood Glucose Meters (Glucometers)
If you have a blood glucose meter but have not been in the habit of using it, it may take a little time to get used to it again, especially if you haven’t used your meter for a long time. If it’s been over two years, you probably should get a new meter. You should replace your meter every 2-5 years.
You should also know that the law allows meters to have a ~20% variance in their readings. “Within the medical community, home blood glucose meters are considered clinically accurate if the result is within 20 percent of what a lab test would indicate. For example, if your glucose meter result is 100 mg/dL, it could vary on the downside to 80 mg/dL or on the upside to 120 mg/dL and still be considered clinically accurate.
In October 2019, “the U.S. Food and Drug Administration (FDA) released its new recommendations on blood glucose meters saying that new meters need to be more accurate. These new accuracy standards mean glucose meter values should be within 15 percent of the lab measurement 95 percent of the time and within 20 percent of the lab measurement 99 percent of the time.
“What this means is that 19 times out of 20, glucose meters should be accurate within 15 percent of the lab value and within 20 percent of the lab value 99 out of 100 times. This should help you feel more confident about the accuracy of your meter if it’s one made after 2016 and the FDA has cleared it. The recommendations don’t apply to older meters.”
Test strips are proprietary to every meter, though some meter manufacturers may use the same test strips for more than one of the meters they make. Test strips are not interchangeable between different brands of meters.
Make sure your test strips have not expired! Expired test strips will give inaccurate results. The manufacturer prints an expiration date on every vial of test strips. Always keep the test strips in their original vial. When you are handling a test strip to put it into your meter, be careful to not touch the part of the strip that receives the blood drop.
Follow your meter’s instruction for use of the control solution. Not all meters require using a control solution, but make sure you know what your meter requires and follow its instructions. If you use control solution, some systems recommend you use it every time you open a new vial of test strips.
Most of the time, it is unnecessary to use a control solution. However, if your readings don’t look “right” to you and seem to have a wide variance between readings taken at about the same time, this would be a reason to use your control solution to make sure your meter is functioning properly. Also, make sure the control solution you use has not expired.
Lancets and Lancing Devices
Most meter manufacturers also make their own brand of lancing device and lancets. But you do not have to use the same brand of lancing system as your meter’s brand.
Manufacturers recommend you use a new lancet for every test. Those of us who have been doing this awhile use a lancet for several tests or until they get dull (because a dull lancet will hurt more than a new, sharp lancet). Rachel Head, a Certified Diabetes Educator, says, “In the grand scheme of things, a fresh lancet is not as critical to your health and well-being as the many other self-care tasks on your plate, like taking medications and counting carbs. If reusing a lancet makes it any more likely you’ll check your blood sugar, it’s fine to let it linger a little longer.”
Adjust your lancing device so that the lancet will go deep enough to get the required size of a blood sample, but not deep enough to bruise or be painful. You may need to squeeze gently to get enough blood, but do not squeeze too hard!
Lancets come in several gauges, from 19 gauge (the thickest) to 38 gauge (the thinnest). The thinner ones hurt less but get dull faster than a thicker gauge and you will need to replace them more often, so you just have to experiment until you get just the right setting for you. Most lancing devices come with 30 gauge lancets, but I prefer 33 gauge lancets.
If you have sensitive fingers or just “needlephobia,” there is a lancing system called Genteel, which a doctor developed especially for children’s delicate fingers and purports to be painless. At the time of this writing, you can find it at https://www.mygenteel.com/, with a one-minute video made by the inventor of Genteel. Prices range from $49.99 to $99.99.
The next best lancing system is the OneTouch® Delica® and Delica® Plus Lancing System. Lancets are available in two sizes for the OneTouch® Delica® lancing devices: 30 Gauge Fine and 33 Gauge Extra Fine. Check your local pharmacy and online sources for pricing and availability. The OneTouch® Delica® website includes an excellent 4-minute instructional video. https://www.onetouch.com/products/accessories/onetouch-delica-plus-lancing-device
How to Test
You have ten fingers and two sides on each finger, giving you a possible 20 sites to stick your fingers for a blood sample. We recommend you use the sides of your fingers, rather than the tips or the pads because there are fewer nerve endings in the sides of your fingers (and thus less pain). Rotate through your 20 test sites.
You should wash your hands before every test! This is to make sure you don’t have something on your hands (like food or anything else) that could interfere with the test. To assure accuracy in testing, always wash your hands with warm, soapy water (preferably with unscented soap), massaging the fingers, and dry your hands thoroughly. If your skin is not dry, the blood sample might become diluted with moisture. Failure to take the simple action of washing your hands with water before pricking your finger could cause falsely elevated readings. Do not use alcohol or hand sanitizer (which contains alcohol) on your fingers before testing! Alcohol will give you a false low.
If you have dry skin and need to moisturize your hands, please do so; but wash your hands before testing and re-apply your hand cream or lotion after you have tested.
It is unnecessary (and not recommended) to use alcohol at home, even though your doctor or nurse may do so in their medical facility. If/when you use alcohol, dry the finger thoroughly with clean gauze before testing. Do not use hand sanitizer (because it contains alcohol); in fact, if you have just used hand sanitizer, be sure to wash it off with warm, soapy water before testing. Use of soap and warm water has the potential to remove—not merely dilute—any potential interference from the skin surface and may provide the additional benefit of increasing localized skin site perfusion (the passage of fluid through the circulatory system).
Caveat: If it is totally impossible to wash your hands properly and all you have is alcohol swabs or hand sanitizer (which is 60%+ alcohol), use it; but make sure your hands are completely dry before performing a finger stick. If you have planned ahead and have clean gauze, use it to dry your testing finger(s).
It is unnecessary to discard the first drop of blood and use the second drop for testing. We recommend washing the hands with soap and water, drying them, and using the first drop of blood for self-monitoring of blood glucose. After washing and drying your hands, massage the fingers together; then massage more on the one finger you’re going to use, especially if your fingers are still cold. After lancing your finger, it’s okay to squeeze it a little to start the blood flowing. Even if a bit of interstitial fluid comes out, it contains about the same amount of glucose as the blood. CGMs (see “Continuous Glucose Monitors” below) measure glucose in the interstitial fluid.
There is an excellent YouTube video on “How to use a blood glucose meter” at https://youtu.be/5B2-DwkFuzA [4:08]. If you are totally new to testing or think you need a “refresher,” please take time to find and watch this video. One important correction: Fasting (and pre-meal) blood glucose should be in the range of 70-99 mg/dL (3.8-5.6 mmol/l), and 1 hour after the first bite of your meal should be less than 140 mg/dL, or 120 mg/dL for good control. At 2 hours after the first bite of a meal, blood glucose should have come back down to close to the pre-meal number.
CGM (Continuous Glucose Monitors)
Continuous Glucose Monitoring (CGM) systems track glucose levels throughout the day. CGM users insert a tiny sensor wire just under their skin using an automatic applicator. An adhesive patch holds the CGM sensor housing in place so the sensor can measure glucose readings in interstitial fluid throughout the day and night. A small, reusable transmitter connects to the sensor wire and sends real-time readings wirelessly to a receiver, so the user can view the information. With some systems, a compatible smart device with the CGM system app can serve as the display device.
CGMs are available only by prescription (at the time of this writing). One popular brand is the FreeStyle Libre, with a sensor you attach to your arm. The sensor pairs with an app on your phone by which you can see the readings. You still have to use your regular glucose meter to check the accuracy of the CGM numbers. One 14-day application costs between $40 and $75, depending on insurance eligibility.
We do not require ketone monitoring to manage your blood sugar. However, some patients who eat very low-carb intending to achieve and maintain nutritional ketosis may want a way to measure ketones. You can measure ketones in the urine, in the blood, and in the breath. “Blood is by far the most reliable and precise way to measure. The reason lies in how your body is actually using the ketones. Measuring your blood ketones (beta-hydroxybutyrate) can provide a quantifiable way to assess your level of adherence.”
Jimmy Moore, author and health podcaster, recommended The KetoCoach blood ketone meter to me. It’s affordable, at $59.95 for a starter kit, at the time of this writing. The KetoCoach website includes a one-minute informational video. Another popular system is the Keto-Mojo, which measures both blood ketones and blood glucose. An older (and more expensive) product that measures both is the Precision Xtra.
Ketonix is the original acetone (ketone) breath measuring device. A newer one is the BIOSENSE™ Breath Ketone Monitoring System. Both are pricey, costing around $300.
Ketostix (for measuring ketones in the urine) is only useful in the beginning stages of ketosis. Most nutritional ketosis experts do not recommend using urinalysis reagents.
More information is available in our chapter on “Ketosis and Ketogenic Diets.”
Adventist Vegetarian Diabetics™ Recommends:
- Learn how to check your blood glucose in the most efficient and least painful way.
- Stay well-hydrated at all times. Sometimes the blood does not flow out easily from your finger stick because you are dehydrated.
- Ideally, check your blood glucose three (3) times a day, but always check your fasting blood glucose (FBG) first thing in the morning.
- Record your blood glucose (in mg/dL or mmol/l) every time you test. You can use a pen and notebook, an Excel spreadsheet or Word table, or an app like Glucose Buddy, mySugr, or others.
- If you are taking diabetes medications and/or insulin, record the times and amounts taken.
- If your fasting blood glucose (FBG) is 100 mg/dL (5.6 mmol/l) or more, continue to test every day. If less than 100 mg/dL (5.6 mmol/l), test once or twice a week. When your FBG is consistently 100 mg/dL (5.6 mmol/l) or less for 6 months or more, you could probably test once a month.
If you are testing to “eat to your meter,” know that one test will require 3 test strips (pre-meal for a baseline, 1 hour after the first bite (when blood glucose typically peaks), and 2 hours after the first bite (when blood glucose should be close to normal again).
all4schwa. “Fingerstick Glucose Testing: Do Alcohol Wipes Interfere w/ Results?” AllNurses (April 27, 2007). https://allnurses.com/general-nursing-discussion/fingerstick-glucose-testing-220967.html (accessed on 7/15/2020).
Alcohol will give you a false low.
Fennell, Diane. “An Important Step for Accurate Glucose Readings,” Diabetes Self-management (March 18, 2015). https://www.diabetesselfmanagement.com/blog/an-important-step-for-accurate-glucose-readings/ (accessed on 7/15/2020).
Failure to take the simple action of washing your hands with water before pricking your finger could result in falsely elevated readings.
“FreeStyle Libre: Check your glucose with a painless scan, instead of a fingerstick.” Abbott Laboratories (2018). https://www.freestylelibre.us/ (accessed on 7/15/2020).
Fruhstorfer, Heinrich. “Blood glucose monitoring: Milking the finger and using the first drop of blood give correct glucose values,” Diabetes Research and Clinical Practice (May 18, 2009). https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(09)00189-2/abstract (accessed on 7/15/2020).
People with diabetes on insulin therapy are often advised to discard the first drop of blood and to refrain from milking the finger when monitoring blood glucose. The first drop is thought to be diluted with tissue fluid with a suspected low glucose content. Milking might enhance the leakage of tissue fluid. However, in normal skin, interstitial fluid is mostly bound and only traces can be squeezed out. Furthermore, in the highly perfused skin of the fingertip the glucose content in blood and interstitial fluid should be almost the same.
Gilles, Gary. Medically reviewed by Richard N. Fogoros, MD. “Guide to Blood Glucose Meters: How to find an accurate monitor that best meets your needs,” VeryWell Health (October 19, 2019; updated June 24, 2020). https://www.verywellhealth.com/how-accurate-is-your-glucose-meter-3289632 (accessed on 7/15/2020).
Head, Rachel, MPH, RD, CDE. “The Lifespan of a Lancet,” OneDrop (March 29, 2019). https://onedrop.today/blogs/blog/how-often-should-you-change-your-lancet (accessed on 7/15/2020).
“In the grand scheme of things, a fresh lancet is not as critical to your health and well-being as the many other self-care tasks on your plate, like taking medications and counting carbs. If reusing a lancet makes it any more likely you’ll check your blood sugar, it’s fine to let it linger a little longer.”
Hortensius, Johanna, RN, et. al. “Self-Monitoring of Blood Glucose: The Use of the First or the Second Drop of Blood,” Diabetes Care. 2011 Mar; 34(3): 556–560. Published online 2011 Feb 17. doi: 10.2337/dc10-1694. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041180/ (accessed on 7/15/2020).
We recommend washing the hands with soap and water, drying them, and using the first drop of blood for self-monitoring of blood glucose.
“How to use a blood glucose meter.” YouTube, Uploaded by Diabetes—What to Know, May 21, 2015. https://youtu.be/5B2-DwkFuzA [4:08]
One important CORRECTION: Fasting (and pre-meal) blood glucose should be in the range of 70-99 mg/dL (3.8-5.6 mmol/l), and 1 hour after the first bite of your meal should be less than 140 mg/dL, or 120 mg/dL for really good control. At 2 hours after the first bite of a meal, blood glucose should have come back down to close to the pre-meal number.
“KetoCoach Starter Kit | Blood Ketone Meter Kit,” KetoCoach (2020) https://ketocoachx.com/products/blood-ketone-meter-kit (accessed on 7/15/2020).
This page includes a one-minute video.
Mahoney, John J., BA, et. al. “The Effect of an Instant Hand Sanitizer on Blood Glucose Monitoring Results,” J Diabetes Sci Technol. 2011 Nov; 5(6): 1444–1448. Published online 2011 Nov 1. doi: 10.1177/193229681100500616. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262711/ (accessed on 7/15/2020).
Use of soap and warm water has the potential to remove—not merely dilute—any potential interference from the skin surface and may provide the additional benefit of increasing localized skin site perfusion.
“OneTouch® Delica® and Delica® Plus Lancing System,” OneTouch (2/26/2020). https://www.onetouch.com/products/accessories/onetouch-delica-plus-lancing-device (accessed on 7/15/2020).
Lancets are available in two sizes: 30 Gauge Fine and 33 Gauge Extra Fine
Page includes an excellent 4-minute instructional video.
WebMD Medical Reference. Reviewed by Michael Dansinger, MD on December 01, 2019. “How Does a Continuous Glucose Monitor Work?” WebMD (2020). https://www.webmd.com/diabetes/guide/continuous-glucose-monitoring#1 (Accessed on 7/15/2020).
“What is Continuous Glucose Monitoring (CGM)?” Dexcom (2020). https://www.dexcom.com/continuous-glucose-monitoring (accessed on 7/15/2020).
How to use a blood glucose meter [4:08]
One important CORRECTION: Fasting blood glucose should be in the range of 70-99 mg/dL (3.8-5.6 mmol/l), and after meals should be less than 140 mg/dL, or 120 mg/dL for really good control.
How to Check Your Blood Sugar
Blood Sugar Monitor: Types, Tips & Tricks
Blood Sugar Monitoring: When to Check and Why
An Important Step for Accurate Glucose Readings
Failure to take the simple action of washing your hands with water before pricking your finger could result in falsely elevated readings
Some Helpful Hints When Monitoring Blood Sugar
For starters, wash your hands before you test, experts say
Fingerstick Glucose Testing: Do Alcohol Wipes Interfere w/ Results?
The Effect of an Instant Hand Sanitizer on Blood Glucose Monitoring Results
Self-Monitoring of Blood Glucose: The Use of the First or the Second Drop of Blood
We recommend washing the hands with soap and water, drying them, and using the first drop of blood for self-monitoring of blood glucose.
Blood glucose monitoring: Milking the finger and using the first drop of blood give correct glucose values
People with diabetes on insulin therapy are often advised to discard the first drop of blood and to refrain from milking the finger when monitoring blood glucose. The first drop is thought to be diluted with tissue fluid with a suspected low glucose content. Milking might enhance the leakage of tissue fluid. However, in normal skin interstitial fluid is mostly bound and only traces can be squeezed out. Furthermore, in the highly perfused skin of the fingertip the glucose content in blood and interstitial fluid should be almost the same.
Testing blood sugar: First or second drop?
The 9 Worst Mistakes You Make When Checking Your Sugar