1. Glucose Monitoring Ceri Jones March 2013

2. Benefits of Glucose Monitoring   Improve glycaemic control?   Empowerment  Hypoglycaemia?  Intercurrent illness/sick day rules  Pre-pregnancy, pregnancy  Driving  Special clinical situations  Intensive regimens

3. Reasons for not BGM Cost The NHS spends approximately £90 million on blood glucose testing materials. This is 40% more than on oral hypoglycaemic agents (£64 million). Inaccuracies  Out of date strips  Contaminated strips  Incorrect meter calibration  Meter reading incorrectly  Sticky fingers  Incorrect sample size  Temperature of equipment

4. Rhondda Cynon Taff 12 months Costs 2003-2004

5. BGM Guidelines NSF Standards 3 and 4  All children, young people and adults with diabetes will receive a service which encourages partnership in decision-making, supports them in managing their diabetes and helps them to adopt and maintain a healthy lifestyle.  All adults with diabetes will receive high-quality care throughout their lifetime, including support to optimise the control of their blood glucose.  All children and young people with diabetes will receive consistently high-quality care and they, with their families and others involved in their day-to-day care, will be supported to optimise the control of their blood glucose.

6. BGM Guidelines NICE Guidelines, 2002  Self-monitoring should not be considered as a stand alone intervention.  Self-monitoring should be taught if the need/purpose is clear and agreed with the patient.  Self-monitoring can be used in conjunction with appropriate therapy as part of integrated self-care.

7. BGM Guidelines DUK Position Statement  People with diabetes should have access to home blood glucose monitoring based on individual clinical need, informed consent and not on ability to pay.  The majority of diabetes care is provided by the individual. It is essential that people with diabetes be provided with the education and tools in order to be able to manage their diabetes for themselves.

8. Glucose monitoring Studies  ROSSO  SMBG decreased diabetes-related morbidity and all- cause mortality  SMBG may be associated with a healthier lifestyle and/or better disease management  Faas  SMBG in T2DM patients questionable needs good RCT  Coster  SMBG established in clinical practice optimal use not established.  Evidence suggests may not be essential for all

9. Technology Meters   numbers available   Not on prescription   Coding & quality control Lancing Devices   Professional   Individual patient   Single use   Not on prescription Lancets  Available on prescription

10. Monitoring Errors  Out of date strips  Contaminated strips  Incorrect meter coding  Incorrect meter  Hands not clean  Temperature of equipment

11. Quality Assurance  Training

12. Quality Control   Accuracy of equipment   Reliability of results   Quality Control solutions   Meter   Strips

13. Quality Control - when?  New meter  New test strips  Change of Batteries  Test strips left open  Meter dropped/damaged  Unexpected result

14. Failed Quality Control  Check expiry dates  Were tests carried out in correct order  Repeat levels 1 and 2 again  Change QC solution & Repeat  Change test strips (change code)

15. Lancing Systems Multiple use device with single use lancet – patients Single use lancet - professional

16. Sharps  Sharps box should be used  Sharps must NOT be put in rubbish  Advice if no sharps box  Sharps disposal service tel: 01443 494700

17. Factors affecting BG levels   Food   Exercise   Physical activity   Illness and pain   Medication   OHAs   Insulin   Alcohol   Emotional stress

19. Contraindications  Severe dehydration  Hypotension / Shock / Peripheral Circulatory failure  Hyperosmolar non-ketotic Coma (HONK)  Diabetic Ketoacidosis (DKA) Venous sample to lab