Blood Glucose Monitoring and HbA1c Targets

This page explains what blood glucose testing is and why it is required for people with diabetes. It covers what the numbers mean, how to control your blood glucose level and how and when to test your blood.

 

Content

 

Blood Glucose Testing

Blood glucose control is very important for people with diabetes.

Checking your blood glucose regularly (using fingerprick testing) shows you how lifestyle changes affect blood glucose levels and helps you maintain control of your diabetes. People with diabetes have an increased risk of developing a number of conditions such as heart, kidney and eye diseases, nerve damage, stroke and poor circulation.

Normal blood glucose ranges for people without diabetes are: 3.5 - 5.5mmol/l before meals and less than 8mmol/l, two hours after meals; the closer the blood glucose is to ‘normal’, the better.

Self-monitoring (through home fingerprick testing) is most appropriate for:

  • patients with type 1 diabetes
  • type 2 diabetes patients who use insulin regimes and adjust their dose as a result of blood glucose testing
  • pregnant patients whether they have type 1, type 2 or gestational diabetes.

Many people with type 2 diabetes, especially those who are diet-controlled, on metformin or a glitazone do not need to perform home blood glucose monitoring. There is no risk of hypoglycaemia, and glycaemic control is better and adequately monitored by regular HbA1c testing.

For patients with type 2 diabetes who are taking a sulphonylurea, a prandial glucose regulator, an incretin mimetic or a gliptin, regular testing is not necessary in normal circumstances. On an individual patient basis testing may be appropriate e.g. as an educational tool, recurrent illness, to ensure safe driving. Where hypoglycaemia is a common occurrence blood glucose should be monitored.

Contact your diabetes care team for advice on home blood glucose meters

Blood Glucose Target Levels

Blood Glucose is checked using finger prick testing. Blood glucose targets are individual to each person, and the target levels must be agreed between the person and their diabetes team. The target blood glucose ranges below (from national guidelines) are indicated as a guide only.

 

 

Waking

Before meals

2 hours after meals

Children - Type 1 Diabetes *

4-7 mmol/l

4-7 mmol/l

5-9 mmol/l

Adults - Type 1 Diabetes*

5-7 mmol/l

4-7 mmol/l

5-9 mmol/l

Type 2 Diabetes**

 

4-7 mmol/l

<8.5mmol/l

Pregnant Women with Diabetes*

<5.3 mmol/l

<5.3 mmol/l

<7.8 mmol/l (1 hr after eating),

<6.4 mmol (2hrs after eating

National Institute of Clinical Excellence (NICE) 2015* & Diabetes UK Council of Health Care Professionals 2015**

HbA1c

When you have a diabetes check-up, a blood sample for the HbA1C is taken. This lets you know what your average blood glucose has been over the previous 3 months. Targets ranges (from national guidelines) are shown below. Evidence shows achieving these levels minimises the risk of long-term vascular complications

 

Target HbA1C

Considerations

Adults- Type 1 Diabetes*

48 mmol/mol (6.5%) or lower

Agree an individualised HbA1c target taking into account factors such as daily activities, aspirations, likelihood of complications, comorbidities, occupation and history of hypoglycaemia.

 

Adults- Type 2 Diabetes*- managed either by lifestyle and diet, or by lifestyle and diet combined with a single drug not associated with hypoglycaemia,

48 mmol/mol (6.5%) or lower

HbA1c targets should be reviewed on an individual basis. The target HbA1c level should be relaxed for those for whom intensive management would not be appropriate.

 

Adults- Type 2 Diabetes*- managed with a drug associated with hypoglycaemia(e.g. insulin or gliclazide)

 

HbA1c level of 53 mmol/mol (7.0%).

For more information HbA1C click here

How do I control my blood glucose level?

Controlling blood glucose is a balance between food, exercise and medication

  • Eat a healthy diet 
  • Take regular exercise 
  • Take your diabetes medication as prescribed 
  • Understand how your medication works in your body 

Why test my blood glucose?

Blood testing is the best method of being in control of your diabetes because it tells you what is happening immediately. It can help determine if you are at risk of a hypo [low blood glucose] or hyper [high blood glucose]. Never change long term medication in response to a one off high or low reading. First establish if there is a pattern before changing your medication. 

What do I do if my blood glucose is high?

If your blood glucose level is consistently above the target set by your diabetes team you may be at increased risk of health problems caused by diabetes.

You may require a change in your medication or advice about avoiding hyperglycaemia. Contact your diabetes care team for advice if your blood glucose is often above target.

What do I do if my blood glucose is low?

If your blood glucose level is below 4mmol/l you are at risk of hypoglycaemia.You may require a change in your medication or advice about diet or lifestyle to avoid hypoglycaemia. Contact your diabetes care team for advice if your blood glucose is often below 4.0 - 4.5 mmol/l. 

When should I test my blood?

The frequency of blood testing will be discussed by a doctor or nurse; information will be given according to the individual's requirements. A general guideline will be given below.

If your diabetes is treated with insulin, you will be asked to test your blood glucose levels more regularly. If the results are within your agreed target range then you may be able to reduce the number of tests. You will be provided with the appropriate advice to suit your own circumstances when you see your diabetes nurse or doctor. If your blood glucose levels are out of target range, you may need to adjust your insulin. Local guidelines may be available via your local services links on home page. It may be advisable to check glucose levels more frequently if you use a 'basal bolus' insulin regime, i.e. adjusting your fast acting insulin dose on a daily basis depending on activity and dietary patterns. The appropriate times to blood glucose monitor when on basal bolus regime are pre meals, pre bed, prior to driving and occasionally 3am readings to assess overnight insulin.

If on a twice daily insulin mixture test blood glucose 4 x daily (pre each meal and bed) in first instance to assess dose requirement. This may be reduced to pre breakfast and pre evening meal one day and pre-lunch and pre bed the next day. Continue to test in this way alternating each day.

When should I test my blood glucose more often?

After a change of treatment
Test more often to ensure your blood glucose is regulated to 4-7mmol/l. This should be discussed at the time of the consultation

Illness 
Your blood glucose may change in response to illness - test blood glucose more often (2-4 hourly especially if you are on insulin). You may require a change in treatment. Discuss sick day rules with your diabetic care team.
If you have type 1 diabetes look up 
If you have type 2 diabetes look up 

Steroid Therapy 
Test blood glucose more often. Steroids may increase your blood glucose levels. You may require a change in treatment.

Preconception and Pregnancy 
Test more often. Blood glucose levels of 4-6mmol/l are desirable before and during pregnancy. Contact your diabetes care team for advice if you are planning a pregnancy or as soon as you know you are pregnant. 

How to do a test 

For a video tutorial of how to conduct a test click 

  • Wash hands in warm water 
  • Prick sides of fingers (less painful)
  • Massage finger from base to tip if necessary 
  • Place droplet of blood on testing strip * Follow strip manufactures instructions precisely [check expiry date] 
  • Check visually or use meter 
  • Keep meter clean and check accuracy regularly using quality control solution as required 
  • Record result in diary 

How do I care for my blood glucose meter?

All meters have manufacture advice brochures, read and comply with the instructions. Helpline telephone advice is available from the Meter Company. Complete the warranty card and return to the company. It is important to quality control your meter regularly. Control solution can be obtained directly from the manufacturer.

Where do I get my strips and lancets?

Your GP will be able to prescribe the equipment you require to use your meter.

Be in control

Testing your blood glucose levels regularly is one sure way of finding out what's happening to your body, so you control your diabetes - not the other way around.

Rate this page