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 300 or higher for more than 3 hours.

• If you have nausea, vomiting, abdominal pain, or trouble breathing.

   

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, usually 15-30 seconds.

• 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.

• Make a note of the date you open the box. Ketone strips expire after opening. The manufacturer instructions will tell you how many months they can be open before discarding. Never use strips after the expiration date on the box.

• 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 moderate or large ketones!

Reviewed June 2024