Diabetes Monitoring

These instructions are for caregivers of Children's Hospital of Philadelphia (CHOP) patients who have been diagnosed with type 1 diabetes. This information is included in basal bolus safety skills training.

Important information about blood sugar monitoring:

What is the normal blood sugar range for people without diabetes?

• Blood sugars that are 70-110 before meals are normal for people without diabetes.

• It is not possible for someone with diabetes to always have blood sugars in this range.

Why is it important to check blood sugars?

• It helps you make decisions about insulin, food, and activity.

• It helps you keep the blood sugars in the ideal range.

What is ideal diabetes management?

• Aim to keep the blood sugar in range most of the time.

• Staying in range most of the time helps keep your child healthy.

• If using a glucose meter: between 70-130 pre-meal.

• If using a continuous glucose monitor: between 70-180, at least 70% of the time.

Instructions for using a glucose meter how to check my child's blood sugar?

• Follow the instructions for your lancing device and glucose meter. The nurse will teach you how to use them.

  • Make sure fingertips are clean and dry.

  • Use one drop of blood.

  • Hold fingertips lower than the heart.

  • Use a new, sterile lancet. Lancets are for one use only.

  • Keep your lancing device and glucose meter clean.

  • Never share a lancet or a lancing device with anyone.

Instructions for using a continuous glucose monitor system

• Your child will likely transition to a continuous glucose monitor system (CGMS).

  • CGMSs are ways to measure glucose levels in real-time throughout the day and night.

  • A tiny sensor wire called a glucose sensor is inserted under the skin (subcutaneous). It measures glucose levels in the fluid in the body's fat tissue. It sends the information wirelessly to a display device (in some cases directly to a smart phone). It can provide alerts and alarms for high and low glucose levels.

• You will learn more about these systems when you are home from the hospital. You should carry your glucose meter, test strips, and lancets as a back-up to the CGMS at all times.

When should I check my child's blood sugar?

• Check before all meals and snacks. You need to know the pre-meal blood sugar to decide on an insulin dose.

• Check blood sugar at least 3 hours after the last insulin injection.

  • Checking sooner may lead to a false high blood sugar.

  • Checking blood sugar 3 hours after a meal tells you if the amount of insulin your child took for that meal is working.

What other times will I need to check my child's blood sugar?

• When you think your child is having a low blood sugar.

• Before, during, and after activity.

• After treating a low blood sugar.

• When your child is sick.

• When you need more information.

• Before your teen drives a motor vehicle.

• When you change your child's insulin dose.

Will I always have to check blood sugar this often?

• Yes. Frequent blood sugar testing is necessary for good diabetes control.

How do I know if the number on the glucose meter is correct?

• If a number on the meter does not make sense, always recheck it.

• The most common mistake is not putting enough blood on the strip. This gives a false low reading.

• Wet fingers can dilute the drop of blood and give a false low reading. Wash and dry hands well.

• Food on the hands may give a false high reading.

What do I do if my meter breaks?

• Call the number on the back of your meter.

  • They can often talk you through the problem on the phone.

  • If not, they will arrange to send you a new meter.

Instructions for checking for ketones:

What are ketones?

• Ketones are strong acids that come from fat breakdown.

• Fat breaks down when there is not enough insulin.

• Ketones are found in the urine and blood.

• Ketones make the body sick.

When should I check my child's urine for ketones?

• When blood sugar is over 240.

• When your child is sick or beginning to get sick (even when the blood sugar level is in range).

• When your child is vomiting.

How do I check the urine for ketones?

• 

  Dip a ketone dipstick into a fresh urine sample or have your child urinate on the end of the strip.

• Do not dip the strip in toilet water.

• You can also squeeze urine from a cotton ball that was placed in a diaper.

• Ketones will turn the dipstick a pink or purple color.

• Refer to the package insert for color codes for your brand of ketone test strips.

• Wait the amount of time stated in the directions.

• Note if urine ketones are negative, trace, small, moderate or large

What else do I need to know about ketone strips?

• Some strips test the urine for more than just ketones. Look for pink-purple ketone color.

• Ketone strips will not work correctly if they have expired.

• Make a note of the date you open the box. Write it on the box. Ketone strips expire in 6 months after opening, or on the expiration date listed on the box (whichever is first).

• Protect your ketone strips from moisture and light.

• Keep the bottle tightly closed when not in use.

• Keep ketone strips in the original container.

Call the Diabetes Center if your child has ketones!

Reviewed on February 1, 2023