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A patient information leaflet: Blood sugar (glucose) monitoring Testing with a purpose is available and should be given to people with diabetes not using insulin to help them understand what to do with the results.
The current annual spend across the formulary area on test strips and reagents is approximately £1.5 million.
The DVLA guidance should be taken into account when considering the need for self-monitoring of blood glucose
Support adults with type 1 diabetes to test blood glucose at least 4 times a day, and up to 10 times a day if any of the following apply:
Enable additional blood glucose testing (more than 10 times a day) for adults with type 1 diabetes if this is necessary because of the person's lifestyle (for example, driving for a long period of time, undertaking high‑risk activity or occupation, travel) or if the person has impaired awareness of hypoglycaemia.
For information on the use of the FreeStyle Libre device, including the local commissioning position, refer to section 6.1.7 FreeStyle Libre interstitial glucose monitor
The view that routine self-monitoring of blood glucose (SMBG) is unlikely to be beneficial in patients with type 2 diabetes who are not treated with insulin has been reinforced by two recent studies (ESMON and DiGEM). SMBG may even worsen quality of life and waste NHS resources.
Recently updated NICE guidance recommends that SMBG should not be offered to people newly diagnosed with type 2 diabetes unless:
A structured review of self-monitoring in type 2 diabetics should be carried out at least annually.
Short term monitoring should be considered when starting treatment with oral or intravenous steroids or to confirm suspected hypoglycaemia.
This list has been compiled with input from local diabetes specialists. Please take caution in deviating from this list under influence from industry sales representatives as the cost of alternate strips and lancets could be significantly higher. Those patients currently using meters that have been removed from the formulary should continue to use them until such time as they and their clinician think it appropriate to change. New formulary recommendations should be followed for all patients new to glucose monitoring in the following groups.
|Meter||Visual impairment||Dexterity problems||Cable free download|
|Accu-Chek® Performa Nano||No||Yes||No|
|AgaMatrix® WaveSense JAZZ||Yes||No||No|
|AgaMatrix® WaveSense JAZZ 'Wireless'||No||No||Yes|
All the following first line meters are suitable for use in type 1 and type 2 diabetes, and may be used in pregnancy and renal dialysis. For patients who are carbohydrate counting, or need to test for blood ketones, please see specialist meters below.
These will be patients with Type 1 diabetes who have received structured education from the local Diabetes Specialist team may need to use specialist meters (as below) to assist them to calculate their insulin: food ratios.
With the advancements in technology of strips, testing blood ketones with capillary blood is much more accurate than testing urine for ketones. Type 1 patients who have unstable diabetes control and have a significant risk of developing ketones (after specialist advice) may benefit from testing their blood for ketones once their glucose level reaches an agreed upper limit and/or in times of acute illness. It is also recommended by NICE for all pregnant women with type 1 diabetes and advised for all those on insulin pump therapy.
Urinalysis, a less accurate method of glucose testing, may be offered to patients who prefer urine testing or those who find blood glucose monitoring difficult. Potential inaccuracies of glucose testing should be borne in mind when using more general urinalysis screening test strips.