Keeping control of your glucose at home

Measuring at home

Your body works best if your blood glucose levels are not too high and not too low. This makes sure you get the most energy from the food they eat, meaning that they can play sports and do activities to their best ability, and concentrate, to their best ability.

People who do not have diabetes have blood glucose levels that stay between 3.9 and 7 mmol/L. If you have diabetes, good control means aiming to keep your blood glucose levels between 4 and 7 mmol/L before meals and on waking, and between 5 and 9 mmol/l around 2 hours after meals most of the time. Careful balancing of your insulin doses, diet and exercise will help you achieve this.

Measuring your blood glucose is the only way of knowing exactly what your levels are. If you go by how you feel, you will only know when you are very low or very high. Please make sure that your child’s meter is with them at all times.

Without readings your diabetes team will not be able to help you, so it is important to review your readings regularly. We recommend that all our patients download Glooko or their device’s recommended software. Please ask a member of the team for more information.

Measuring and monitoring blood glucose levels

This can be done at home, school or when out and about by doing regular finger prick checks, with the equipment we will give you.

It is recommended that you check at least before each meal, before bed and when you feel low (hypo) or unwell. If your glucose level is high (more than 9mmol/L) it is important to check that it has come back to normal within 4 hours.

The children who have excellent control test on average 6 to 8 times each day and achieve 70 to 80 percent of their results in the target range.

Extra tests may be needed at other times such as during illness, following a hypo, stressful periods such as exam time or during a growth spurt.

Patterns and trends of blood glucose levels that are too high or too low are more easily identified with regular monitoring and reviewing.

If blood glucose levels are significantly high (14mmol/L or more) check for blood ketones. If blood ketones are above 0.6mmol/L and rising, immediate action must be taken because you are in danger of becoming seriously ill very quickly.

The number displayed on the meter tells you how much glucose is in the blood stream at the time that the test was carried out. It is measured in units called millimols per litre.

Recommended blood glucose targets for children with diabetes are:-

• when waking: 4 to 7 mmol/L
• before meals at other times of day: 4 to 7 mmol/L
• after meals: 5 to 9 mmol/L
• before bed: 5 to 8mmol/L

The blood glucose result indicates the action you will need to take to manage your diabetes well on a day to day basis.

Insulin doses are adjusted according to patterns and trends of the blood glucose levels to achieve better control.

If the blood glucose level is high for example, 8mmols/L or more before a meal then additional insulin is recommended. This is called a correction dose or insulin sensitivity factor (ISF). You will be informed of your ISF by the diabetes team. Your expert meter will be programmed to automatically calculate this for you.

Within 2 to 4 hours, or by the next meal, the blood glucose level should then return into the target range. The ISF will change over time as you grow.

Looking for patterns and trends of rising or low blood glucose levels, and looking for reasons will give you clues as to the changes required to get back to your target level.

Before changing insulin doses you need to consider other things, such as injection sites, rotation, exercise and food.

How to keep track of blood glucose readings

Think about the balance between insulin, food and exercise. If blood glucose readings are out of target this could be due to an incorrect balance between the diet, exercise levels and either the basal dose or the bolus dose of insulins.

Most children use a “basal bolus” regime (also known as multiple dose insulin (MDI)). In this regime, there is a slow release background insulin (Levemir) providing a small dose of insulin through the day and a bolus dose of quick acting insulin (NovoRapid) as necessary to cover food eaten and bring down high blood glucose readings.

If the rise is after a meal and a bolus dose, then it is likely that it is your bolus insulin dose that needs changing.

Is my carbohydrate counting correct?

Often portion sizes gradually get bigger without you realising it. Reweigh them to double check and look again at the packet labels. Pasta, rice and cereals can be very hard to guess accurately. Always check you have not included the weight of the plate in your calculation.

Have I been doing more or less exercise than usual?

You may need to reduce or increase your insulin doses depending on when you exercise. Ask for advice if you are not sure.

Do I always give insulin for snacks?

All snacks containing carbohydrate need insulin.

Is my insulin to carbohydrate ratio (ICR) correct?

As people grow up they often need more insulin for the carbohydrate they eat. You may need a different ratio at different times of day.

Is my correction dose (ISF) correct?

If your usual correction dose does not bring down a high reading after 2 hours as you would expect, you probably need to use more. In puberty many people find they need 1 unit for a to lower glucose by 2 to 3mmol/l

Am I unwell?

If you do not feel well and your blood glucose readings are over 8mmol/l, always check your blood for ketones and follow the sick day rules leaflet (or phone the team)

Try thinking about the following questions to work out what is going wrong

Is there a pattern to my out of range readings? For example, is it at the same time of the day? Same day of the week? After sport? If not sure do some more checks to find out.

Which insulin is working at the time they go out of range?

If more than 4 hours since your last quick acting insulin it is probably your background insulin. Your background insulin should also hold your blood glucose readings steady overnight. Test before bed and breakfast time and if they are drifting up it is likely that you need more background insulin.