Self blood glucose monitoring and patient engagement

In July 2016 the Australian government brought in changes to the NDSS, restricting subsidised supply of blood glucose test strips to people with type 2 diabetes NOT on insulin. This was a cost saving decision, but unfortunately, it sent the message that people with type 2 diabetes do not need to monitor their blood sugar levels. People with type 1 diabetes, gestational diabetes, and those using insulin must monitor their blood sugars closely and are exempt to these restrictions.

The HbA1c test is a blood test that checks someone’s average blood sugar control over approximately 3 months. There are a number of limitations to this test, and it doesn’t help an individual make everyday decisions with regards to their blood sugar. As the HbA1c goes up, the accuracy of the test goes down, underestimating their average blood glucose levels. For example, someone with an HbA1c of 9% has blood sugars averaging 12mmol/L, and someone with an HbA1c of 13% has blood sugar levels averaging 18mmol/L! The other problem with the HbA1c is that if someone is experiencing highs and lows (which are the most dangerous), these can average out to look ok, giving them a false impression.

Monitoring blood sugar levels without actually knowing when to check, how to interpret them, and what to do with them can be confusing and sometimes frustrating. A diabetes educator can work with individuals to help them learn and understand how to self-blood glucose monitor.

Most people just monitor their fasting blood sugar levels (this is their blood glucose level first thing in the morning, before eating or drinking), and this is often at the request of their doctor. Fasting blood sugar levels should theoretically be the most consistent blood glucose reading, with less day to day variability, so it can be a good way to track whether the diabetes is progressing. Six months can be a long time in between blood tests so if patients are monitoring their own blood sugars levels, they will be able to pick up on rising blood sugars sooner. This is a good start, but it doesn’t tell them much, and it’s a more reactive way to manage diabetes.

When people with diabetes monitor their own blood sugar levels, they learn an awful lot. It’s a tool to help them make adjustments to their diet and lifestyle. You won’t know what’s going on unless you pop the hood and have a look. The more someone monitors their blood sugar levels, the more they will start to pick up on patterns and trends; helping them to make more informed decisions.

Educating individuals on what, why, how and when to check their blood sugar levels empowers them to take control of their diabetes. It also helps to hold them accountable. The reading won’t lie, so it’s a good way to keep them on track.

Pricking your finger isn’t the most pleasant thing to do so I ask my clients (with type 2 diabetes) to check one blood glucose pair a day and alternate between breakfast, lunch and dinner. This way they get a nice profile across the week without destroying their fingers! If their blood sugars are consistently within range, they can have a break for a while if they wish, but I always recommend checking in again from time to time.

If someone is getting anxious about checking their blood sugars it’s okay to have a break, but if the anxiety is because they are worried or know their blood sugar levels will be high, then they really ought to speak to their health provider so something can be done. If their blood sugars are high, they need to be addressed. The longer they leave it, the more anxious they will get.

I also find that some people are averse to checking their blood sugars because they are ashamed of, or in denial about, having diabetes, and checking their blood sugar is a reminder that they have it. This is a psychological barrier that should be addressed in a sensitive manner to help the individual come to terms with the diagnosis so they can start making positive steps forward.

As providers, we have a tendency to want to solve our patient’s problems, but we can’t make decisions for them everyday. Blood glucose monitoring is a tool that we can offer our patients so they can make more educated decisions for their diabetes management. We want to put the power back into their hands and support them so they feel confident managing the diabetes themselves.

I have included a link here to my You Tube channel, which has educational videos for people with type 2 diabetes. I encourage you to direct your patients there. I will be posting many more. (Please excuse the sound quality – we only realised too late that the microphone wasn’t working!)


This article has been written for the Australasian Society of Lifestyle Medicine (ASLM) by the documented original author. The views and opinions expressed in this article are solely those of the original author and do not necessarily represent the views and opinions of the ASLM or its Board.

Juliet Richards is a Consultant Pharmacist, Credentialed Diabetes Educator and an ASLM-Certified Practitioner in Lifestyle Medicine.

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