Glucose monitoring guidance
This is recommended guidance based on good practice. This guidance should not replace local guidance or policies. Glucose monitoring should only be conducted by those who have been assessed as competent to do so. Equipment to glucose monitor should be as per recommended meters used in line with all Wales recommended meters and equipment. Equipment should always be quality assured and used as per manufacturers guidance.
The main purpose of glucose monitoring is to:
- keep the person with diabetes safe
- monitor and prevent hypoglycaemia and/or hyperglycaemia
- maintain glucose levels to agreed individualised targets
- ensure treatment is effective
- improve overall diabetes management to prevent complications or further deterioration of existing complications
Routine monitoring of glucose is recommended in the following circumstances (NICE 2020)1National Institute for Health and Care Excellence (NICE) (2020) Managing blood glucose in adults with type 2 diabetes. Chapter 4 NICE Pathways. London: National Institute for Health and Care Excellence.:
- the person is on insulin
- there is evidence of hypoglycaemic episodes
- the person is on oral medication that may increase their risk of hypoglycaemia
- the person is on steroids
If a person living with diabetes is self-monitoring blood glucose levels, an annual assessment should be carried out as a minimum, to assess:
- the person’s self-monitoring skills
- the quality and frequency of testing
- check the person knows how to interpret glucose results and what action to take
- the impact on the person’s quality of life
- the continued benefit to the person
- the equipment used (including sharps bin, glucometer, lancet device)2National Institute for Health and Care Excellence (NICE) (2020) Managing blood glucose in adults with type 2 diabetes. Chapter 4 NICE Pathways. London: National Institute for Health and Care Excellence.
Glucose testing should not be performed unless individuals have been educated and trained do so. If you are employed as a carer you should only be performing this procedure as per your local guidance.
Frequency of testing recommendations
| Person with diabetes | Frequency of monitoring |
|---|---|
| All people admitted to care/nursing homes | Test on admission to care/nursing home |
| Once daily insulin | Monitor pre insulin injection (once in 24 hours) |
| Twice per day insulin | Monitor pre insulin injections (2 tests minimum in 24 hours) |
| Four times per day insulin | Monitor pre insulin injections (4 tests minimum in 24 hours) |
| Oral medication with risk of hypoglycaemia e.g. Gliclazide; Glibenclamide; Glimepiride; Glipizide; Nateglinide | Monitor at least once per day at any pre meal time (1 test minimum in 24 hours) |
| Unwell | Increase monitoring (minimum of 4 tests per day, include pre meal and pre bed and overnight testing if needed) |
| Hypoglycaemia (less than 4mmol/L) | Treat as per local or recommended national guidance; monitor every 10 - 15 minutes until level is to agreed individualised target |
| Changes in diabetes treatment with risk of hypos e.g. Insulin; Gliclazide etc. | Monitor pre meals and pre bed (four tests per day for minimum of 3 day)s until glucose levels are stable and then follow recommendations or local health professionals instructions |
Adapted from Medicines and Healthcare products Regulatory Agency (MHRA), 2013.
https://www.magonlinelibrary.com/doi/full/10.12968/bjon.2019.28.7.434#B18
- 1National Institute for Health and Care Excellence (NICE) (2020) Managing blood glucose in adults with type 2 diabetes. Chapter 4 NICE Pathways. London: National Institute for Health and Care Excellence.
- 2National Institute for Health and Care Excellence (NICE) (2020) Managing blood glucose in adults with type 2 diabetes. Chapter 4 NICE Pathways. London: National Institute for Health and Care Excellence.
