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    Nancy Klobassa, R.N., and Peggy Moreland, R.N.

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  • Feb. 10, 2009

    Overcoming barriers to self-monitoring of blood glucose

    By Nancy Klobassa, R.N., and Peggy Moreland, R.N.

28 comments posted

Monitoring your blood glucose is an important part of effective diabetes management. It is especially important for people who take insulin. Many people find that it is difficult to make blood glucose monitoring a routine part of their lives. So, if you are struggling with checking your blood glucose as recommended by your healthcare provider, you are not alone.

An American Diabetes Association survey found that "21 percent of adults with type 1 diabetes never checked their blood glucose. Of those with insulin-treated type 2 diabetes, 47 percent never monitored, and among those with type 2 diabetes who were not using insulin, 76 percent never checked.''

William Polonsky, in his book "Diabetes Burnout," lists the top 10 reasons to hate checking your blood glucose. They are as follows:

  1. Your meter makes you feel bad about yourself.
  2. Monitoring seems pointless (because you believe there is nothing you can really do about your blood glucose results anyway).
  3. Checking your blood glucose reminds you that you have diabetes, which is something you'd probably rather not think about too much.
  4. Your meter seems to control your life, telling you what you can and cannot do.
  5. Monitoring serves as an opportunity for your friends and family to bother you.
  6. None of your health care providers ever do anything with the results anyway.
  7. Checking blood glucose sometimes hurts.
  8. Monitoring can be inconvenient.
  9. Monitoring can be expensive.
  10. Life is too busy and demanding to take the time for regular monitoring.

What are your personal barriers?  If you know what your personal barriers to checking your blood glucose regularly are, there are things that you can do to overcome them. Some general tips:

  • Glucose readings are just numbers. They are not judgments of your ability to manage your diabetes. Think of your test results as a check — not a test. Blood glucose testing is a tool that you can use to evaluate the effectiveness of your diabetes care plan. Results can be used by you and your healthcare provider to adjust your treatment if needed. Also remember that no matter how hard you have been trying to manage your diabetes, there will be times that your glucose levels are not in your target range.
  • Be realistic. Work with your healthcare provider to determine your blood glucose goals.
  • Use your knowledge to manage your diabetes from day to day. Work with your healthcare provider to fine-tune your diabetes care plan by adjusting your meal plan, activity level, and/or your medication to help meet your blood glucose goals.

We look forward to hearing from you. Please share your experiences with glucose monitoring. Do you find it hard to make glucose monitoring a routine part of your life?

- Peggy

28 comments posted

blog index

  • November 19, 2009 9:49 p.m.

    Anita: Newer meters require much smaller samples. Here are a few tips: 1. Use the clear cap on lancing device 2. Besides the arms, you can use the fleshy part of the palm and base of thumb. 3. Rub the area selected with your hand for a few seconds. 4. The area to be lanced should be lower than your heart (gravity). 5. Press the lancing device against the skin with moderate pressure 6. Hold the lancing device down on the skin to force the blood out until you can see the amount of blood needed. Remember that alternative glucose testing site results may differ from fingertip testing (which is the most accurate). Test from the fingertip when you note that glucose levels are changing rapidly (i.e. after exercise). Use fingertip blood glucose testing if you think your blood sugar is low or if you are not aware of symptoms when you become hypoglycemic, or if the alternative site results do not agree with the way you feel.

    - Nancy and Peggy

  • November 7, 2009 8:42 a.m.

    Sticking my finger 3 times a day for three months has got my fingers bruised and sore. Is there another way to test B.S.L. without drawing blood from my fingers? I have tried to poke my arms but blood will not readly come out in sufficient amount to activate the meter.

    - Anita

  • October 19, 2009 5:02 p.m.

    i never check my bloodsugar, im so ashamed of it. Ill have good intentions, then i just fall off the wagon again.

    - shay

  • June 23, 2009 9:27 a.m.

    Many patients are so used to being blamed and criticized for their efforts at diabetes self-management, that they are reluctant to see their healthcare provider. Your thoughts on this subject?

    - Nancy and Peggy

  • June 18, 2009 11:13 a.m.

    Checking my blood glucose just gives my doctor another reason to express his "disappointment"

    - JM

  • June 4, 2009 11:39 a.m.

    MB: We just want to reassure you. Diabetes is a progressive disease. You can do everything right and still eventually need to go on medication. Keep up the good work and learn all you can about diabetes at the education classes. Your feelings are normal but please discuss them with your healthcare provider.

    - Nancy and Peggy

  • May 28, 2009 9:46 p.m.

    I've recently been diagnosed with type 2 diabetes. My Dr. told me five years ago to diet and exercise, which I tried, but obviously failed at doing. I thought I was trying hard and feel like I've brought this disease on myself. I'm so depressed and cry so much that I don't think I have any tears left. Yet somehow my body produces more. I've been on metformin once a day for 5 days and have tested a lot but my numbers are high in the morning and low after dinner. Can I have after dinner snacks? I have to go to more diabetes education classes, but I need to know that I will soon know what I can and can't eat. I feel hungry all the time. I'm on information overload right now. Are my feelings normal. Thanks for any help you can give me.

    - MB

  • April 23, 2009 2:28 p.m.

    About diabetes burnout, diabetes burnout is common amongst diabetic individuals because of the high maintenance involved with diabetes management. A good book on diabetes burnout is "Diabetes Burnout" by William Polansky. The author explains symptoms of burnout, why it happens and what you can do about it.

    - Nancy and Peggy

  • April 23, 2009 2:13 p.m.

    Readers, any advise for newbie? If you haven't already, I would recommend you see a certified diabetes educator (CDE) and dietitian. Diabetes is a balancing act and it is important to know what affects your blood glucose and how to balance it. I would endorse any books promoted by the American Diabetes Association (ADA). Mayo Clinic has a new book on diabetes, "Mayo Clinic The Essential Diabetes Book".

    - Nancy and Peggy

  • April 17, 2009 12:15 a.m.

    Suffering from major burn out and trying to break out of the rut I'm in. I've been T1D for 14y and I've progressively been checking BG less and less...I'm trying to figure out why I'm on this path, but more how do I get off!!!

    - Lisa

  • April 2, 2009 8:23 p.m.

    Hello All Monitoring can be tedious but it beats the alternative of not knowing what is happening so you can take action. I have been a diabetic for close to 40 years and was very glad when the monitors came out for personal use in the early 80's. No more guess work, urine tests or waiting for the Doctor's office to call with the results. I now have a 5 second meter that talks to my pump. Makes life much simpler and easier. All of you who are working at monitoring keep at it - you are the only one who can do it. Life is much better knowing and controlling than not. CA

    - CA

  • March 29, 2009 3:04 p.m.

    I absolutely hate monitoring, and the reasons are very much the ones you cited: I don't like the constant reminder I have diabetes, it hurts, nothing ever seems to be done with the results except to allow my doctor to pass judgement on me based on the numbers, and it is depressing--I feel like crying every time I test, whether the results are "good" or "bad". It is a constant reminder I can no longer eat what I want, when I want, or as much as I want.

    - outback

  • March 26, 2009 4:14 p.m.

    Having just been diagnosed with diabetes and faced with all the new tasks involved with managing your diabetes can seem overwhelming at first. As you become more familiar with the process, it will become more routine and less time consuming. Remember, it's an ongoing learning process and you are not expected to know it all initially.

    - Nancy and Peggy

  • March 24, 2009 5:46 a.m.

    I've been diagnosed about one month. My doctor wants me to keep a log that summarizes weight, cals, carbs, blood pressure, blood sugar, insulin taken and times. When I include the time spent planning meals (I carb count), it seems that my whole day is devoted to maintenance. I know that my doctor wants me to learn and recognize conditions and trends, but will this level of tracking always be necessary?

    - Al

  • February 24, 2009 9:44 p.m.

    I have type 1 diabetis and without checking your BG I would not know how much insulin to give. Check blood on average 6 to 9 times a day and so used to it that it does not bother me a bit. Would be glad if I did not have to but there is no other way to take care of my diabetis. Ann

    - Ann

  • February 19, 2009 5:50 p.m.

    I "solved" one my challenges to glucose monitoring by putting glucose monitors in various parts of the house, so I never had an excuse of not having a monitor handy. One in my purse, one in the kitchen, one in the bedroom. I also keep fast-acting insulin pens in these locations. It was such a simple change, but has had a major effect because now it is almost always "convenient" to test and dose.

    - JO

  • February 19, 2009 3:38 p.m.

    Do you respond to email?

    - No name given

  • February 19, 2009 12:23 p.m.

    Sorry, forgot to sign our names. Nancy and Peggy

    - No name given

  • February 19, 2009 12:20 p.m.

    We could not find the specific ADA survey, but have read several studies that the 21% figure is about right. Some more recent studies indicate that self blood glucose monitoring adherence has improved in the past decade. In an article in the American Journal of Medicine, it states that “adherence with the recommended frequency of self-monitoring was more common among patients with type 1 diabetes (34%) or insulin-treated type 2 diabetes (54%) than among patients with oral agent only treated type 2 diabetics (20%).” This study found that more frequent self-monitoring of blood glucose improves glycemic control regardless of diabetes type or therapy. Karter, A.J., Ackerson, L.M., Darbinian, J.A., et al, Self-monitoring of blood glucose levels and glycemic control: The northern California Kaiser Permanente Diabetes Registr, American Journal of Medicine, 2001, vol. 111:1-9.

    - No name given

  • February 18, 2009 10:12 a.m.

    does anyone know where I can find a report on this ADA survey?

    - Amy

  • February 18, 2009 7:14 a.m.

    I have had type 1 diabetes for 53 years, I keep my weight under good control, blood readings do very a lot I test 5 times a day, take short acting and long acting insulin, I've just learned to take care of myself, it's really not that bad, just hang on diabetics, life could be a lot worse.

    - Ella

  • February 14, 2009 10:19 p.m.

    I was overweight and depressed for years until I came across this amazing program called fit4lyfe.It completely changed my lifew hile maintaining who I was. It takes into consideration that a dieter and person who works out needs a life and has a life,maybe kidss too, and for me I hated working out. This program is a personalized one on one approach to successfully eating and working your way to losing weight and feeling great! check it out www.fit4lyfe.webs.com

    - marisa

  • February 12, 2009 9:46 a.m.

    Sorry, I forgot to put my name to my posting.

    - Mike

  • February 12, 2009 9:42 a.m.

    Tom, firstly worrying is going to be Detrimental to your glucose levels. I have type 1 diabetes 50 years. I do up to 10 tests per day. I think if your HbA1c is reasonable then you are doing well. I know my bgs tend to be like yours, up and down all day, but my doctor tells me as long as the HbAic is ok then not to worry about it. Even non diabetics have varying bg levels each day. Woohoo, I'm off to Italy for a cycling holiday in September.

    - No name given

  • February 11, 2009 1:18 p.m.

    Itest morning fasting, then before lunch, before dinner and 2 hr in evening...short-acting insulin before meals per sliding scale, Regular at bedtime. Most of the time blood sugar is well controlled, even though I don't follow a meal plan, other than ignore most white foods(except potatoes, my weakness). Blood sugar stays in good control on this plan and it's easy to follow. AlC is good on this plan, according to doctor. I also take cinnamon caps morning and evening and this seems to help a great deal. Anyone else tried this? Lois R.

    - Lois

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