To keep your child's blood sugar levels under control, you have to know what those levels are. Checking blood sugar levels (also known as blood glucose levels) according to your child's diabetes management plan will help you and your child:
- feel more aware and in control of what is happening with your child's diabetes
- prevent short-term diabetes symptoms and future health problems
- troubleshoot problems and make adjustments to your child's diabetes management plan more promptly and effectively
- manage sick days
- gain a better understanding of the impact of food, exercise, and medications on your individual child's blood sugar levels
When to Check Blood Sugar Levels
The number of times you should test your child's blood sugar levels each day - and when you should test - will depend on a number of factors. It might even change from day to day. In general, most kids with diabetes test their blood sugar levels before breakfast, before lunch, and before dinner, and then again at bedtime. They may need to check more often when they're sick or when there are any changes in their diabetes treatment or daily habits. They may also need to check more frequently if they use an insulin pump or another management plan that aims for very close control of blood sugar levels. Your child's diabetes health care team can advise you on how often and when you should check your child's blood sugar levels.
Sometimes parents of children with diabetes need to check their child's blood sugar levels in the middle of the night. For example, kids who have been having problems with hypoglycemia episodes may need middle-of-the-night tests. In addition, children who have just been diagnosed with diabetes may need more frequent blood sugar level tests as they and their families are just beginning to get a feel for how insulin or other diabetes medicines affect their child's blood sugar levels.
How to Check Blood Sugar Levels
Blood glucose testing is easier, less painful, and more accurate than it used to be. Blood sugar levels can be tested with a blood glucose meter, which is a computerized device that measures and displays the amount of glucose in a blood sample.
To get a blood sample, a small needle called a lancet is used to prick the skin (usually on a finger or the forearm) to draw a drop of blood. The drop of blood is placed on a testing strip that goes into the glucose meter, and the blood glucose reading appears on a screen within a few seconds.
How do you know which glucose meter to use? Most people with diabetes end up choosing the type of blood sugar testing equipment covered by their insurance plans. However, there are many types of glucose meters available with different features. When choosing a glucose meter, you should consider the cost, how user-friendly the device is, and what types of features are important for you and your child:
- Cost: Although most insurance plans cover the cost of glucose meters and test strips, there may be a limit to the number of test strips they cover (and test strips are the most expensive part of monitoring blood sugar levels). Make sure you know what your insurance will cover before investing in a glucose meter.
- User-friendliness: Choose a glucose meter that is easy to use and maintain. For example, a glucose meter that doesn't require large blood samples might be better for small children, and an easy-to-calibrate meter might be better for teens, who are taking on more of their own diabetes care. Glucose meters that take less time to give results may also be preferred.
- Special features: Glucose meters are available in both large, easier-to-handle sizes as well as small, more portable sizes. Other features may include memory storage and the ability to record additional information like date, time, food intake, and exercise. The ability to download glucose readings into a computer program may be a desirable feature for some families.
Other new technologies make it easier to keep track of blood sugar levels. Adjustable lancets can make finger pricks less painful by changing the depth to which the needle enters the skin. Certain glucose meters can use blood drawn from a forearm or other body parts that may be less sensitive than a fingertip for some people. Your diabetes health care team will help you choose the best type of equipment for your child.
In some cases, your child's doctor may want to get an even more detailed look at the fluctuations of your child's blood sugar levels throughout the day and night. A wearable device is now available that can measure blood sugar levels every 5 minutes over a 3-day period, and a computer printout of the person's blood sugar profile can be downloaded at the end of the test for the doctor to evaluate. A sensor must be inserted under the person's skin and the results interpreted by a medical professional.
This testing system is not practical for routine blood sugar monitoring because the sensor would have to be replaced every 3 days, and the blood test results cannot be viewed until the 3-day testing period is over.
Other Tests to Help Keep Track
Using a glucose meter can help you check your child's blood sugar levels, but there are other tests that will help you know how well your child's diabetes is being controlled.
The glycosylated hemoglobin (hemoglobin A1c or HbA1c) test will give you an overall picture of what your child's blood glucose control has been over the 2 to 3 months before the test is done and is usually performed during regular clinic visits with your child's diabetes health care team. Hemoglobin is the substance inside red blood cells that carries oxygen to the cells of the body. The higher the glucose level is in the blood, the more it sticks to the hemoglobin. And once hemoglobin picks up glucose, the glucose stays on it for the life of the red blood cell, which is about 2 to 3 months.
The most commonly measured type of hemoglobin in the blood that has glucose attached to it is called HbA1c. In general, the lower (and closer to the levels seen in people without diabetes) your child's HbA1c, the better controlled your child's blood sugars have been over the preceding 2 to 3 months. Having lower HbA1c levels over years is associated with a lower risk of future health problems related to diabetes.
Another important test is one that checks for ketones in the body. Ketones are chemicals that show up in the urine and blood after the body breaks down fat for energy. The body will break down fat when it can't use glucose. This can occur when there isn't enough insulin to help the glucose get into the cells, or when not enough food has been eaten to provide glucose for energy (such as when a child is ill).
Having lots of ketones in the body can put your child at risk for a major diabetes emergency called diabetic ketoacidosis. Diabetic ketoacidosis can make kids very sick, so it's important to test for ketones when necessary before they build up in the body. It's an easy test to do at home. Your child's diabetes health care team will let you know how and when to test for ketones - usually when your child is having consistently high blood sugar test results or is ill with vomiting or other symptoms that can occur with diabetic ketoacidosis. They will also teach you how to interpret the results as part of your child's overall treatment plan.
Record Keeping
Even though glucose meters can help keep track of your child's blood sugar test results, it's still a good idea to write down the results because this makes it easier for you and your child's diabetes management team to see patterns and trends in your child's blood sugar levels. This will not only help you and your child better understand the link between food, activity levels, and blood sugar levels, but will also help you and your child's diabetes health care team make adjustments to your child's diabetes management plan.
Reviewed by: Steven Dowshen, MD, and Elana Pearl Ben-Joseph, MD
Date reviewed: July 2005
