Diabetes – blood glucose monitoring at home (adults) – clinical guideline, v1 Principal author: Prof D Bowen-Jones & Dr KS Leong (WUTH), Mrs V Vincent (NHS Wirral) Approved by Wirral Clinical Guidelines SubCommittee: January 2013 Review by: January 2015

Clinical Guideline

• Self monitoring skills

Type 2 Diabetes Self-monitoring of blood glucose should be offered to all newly diagnosed type 2 diabetic patients as an integral part of self-management education. Discuss purpose and agree how it should be interpreted and acted upon. Frequent testing is not required in stable well-controlled individuals. Assess the following at least annually:

• Quality and appropriate frequency of testing • Use made of the results obtained • Impact on quality of life • Continued benefit • Equipment used

To determine an appropriate frequency of testing, the following criteria should be followed for patients with type 2 diabetes: 1 All newly diagnosed patients should initially monitor frequently in order to provide them with information in relation to their activities and the effect of dietary

measures and treatment prescribed. 2 For patients who are stable, monitoring should be done between once and twice monthly (fasting, pre-breakfast). 3 Patients taking sulfonylureas should monitor at least twice weekly (fasting, pre-breakfast). This applies particularly to patients on longer acting agents. 4 Patients who experience the following should monitor their blood glucose levels more frequently:

(a) Inter-current illnesses (b) Change in oral hypoglycaemic treatment (c) Co-prescription of systemic steroids (d) Exercise (e) Carbohydrate counting (f) If there are difficulties in venesection or if glycosylated haemoglobin is unreliable*.

1. Inter-current illnesses

Type 1 Diabetes (and type 2 diabetes using insulin therapy) For patients who are stable, blood glucose should be tested four times a day (pre-meals and pre-bed) on two days per week. Patients may need to adapt the frequency of their blood glucose testing due to numerous factors. These include:

2. Carbohydrate counting 3. Pregnancy 4. Before driving 5. Exercise 6. Poor control (plus other advice as per point 4 under Type 2 Diabetes section) Access to testing strips MUST NOT be restricted for patients using insulin or for paediatric patients (excluded from this guideline).

Since November 2011, patients with insulin treated diabetes can apply for a class 2 driving licence. These applicants must meet standards specified by the DVLA including evidence of adequate control of diabetes by regular blood glucose monitoring (at least twice daily and at times relevant to driving). For these patients only, a blood glucose meter with a memory function to measure and record blood glucose levels for at least

Class 2 driving licence (Lorries & Buses) advice for patients with diabetes – new recommendations

three months prior to submitting their application must be used.

*Glycosylated haemoglobin may be unreliable in the following situations: (i) Patients with anaemia; (ii) Patients with polycythaemia; (iii) Patients with haemoglobinopathies; (iv) Patients in whom venesection is not possible

DIABETES – BLOOD GLUCOSE MONITORING AT HOME (ADULTS)

Diabetes – blood glucose monitoring at home (adults) – clinical guideline, v1 Principal author: Prof D Bowen-Jones & Dr KS Leong (WUTH), Mrs V Vincent (NHS Wirral) Approved by Wirral Clinical Guidelines SubCommittee: January 2013 Review by: January 2015

Best for … Type 2 diabetics Type 2 diabetics / visually impaired

Patients using insulin / frequent testers

Frequent testers / those requiring large memory

Patients using insulin / frequent testers

Patients requiring ketone testing

Meter Name

GlucoRx Nexus

GlucoRx Nexus Mini

Supercheck 2

Aviva

Aviva Nano

BGstar

Contour XT

FreeStyle Optium

Testing Strips (price correct as of November 2012)

GlucoRx Nexus £9.95 / 50

SuperCheck 2 £8.49/50

Accu-chek Aviva £15.41/50

BG Star test strips £14.73/50

Contour Next £14.85 / 50

FreeStyle Optium £15.33/50 / FreeStyle Optium β Ketone £20.63/10

Shelf life once opened

3 months (but comes as 2 x 25 strips)

3 months Until printed expiry date even if pot opened

3 months Until printed expiry date even if pot opened

Until printed expiry date as individually wrapped

Special features

Ketone warning

Small, portable device

Talking meter as recommended by RNIB (this function can be turned off)

Battery backup

Small, portable device

Sister meter iBGStar (using same strips) can be attached to iPhone and iPad (must be purchased)

No coding, quality control testing sensitive

Blood glucose testing with the added function of ketone testing

Memory 1000 1000 500 500 500 1865 480 450

Compatible Lancets and Lancing Device

GlucoRx Lancing Device and Lancets

Supercheck 2 Lancing Device and Lancets

Accu-chek FastClix Finger Pricker and FastClix Lancet Drum

BGstar Lancing Device and Lancets

Microlet 2 Device and Microlet Lancets

Easy Touch Lancing Device and Lancets

Company / Customer Care Line

Dime 01483 755 133

Apollo Medical Technologies 01636 831 201

Roche Diagnostics 0800 701 000

Sanofi Aventis 0800 0352525

Bayer Diagnostics 0845 600 6030

Abbott Diabetes Care 0500 467 466

Quality Control solution shelf life once open

3 months 3 months 3 months 90 days 6 months 90 days

Consumables (e.g. batteries, Quality Control solution, USB cables etc.) are available free of charge from the Company Customer Care lines. Software download is available for all the meters listed. When changing a patient’s meter please help reduce waste where possible by ensuring test strips for the previous meter are used before ordering the new strips. For Bolus Advisor Systems, Insulin Calculators and/or Carbohydrate Counting Either the Accu-chek Aviva Expert (Aviva test strips) or the FreeStyle InsuLinx (FreeStyle Lite test strips) may be used.