Building Independence: Check + Treat BG

passing the T1D baton: Checking + Treating Blood Glucose

We all know that eventually our T1D child needs to be able to care for their diabetes for themselves. But how do we hand over that baton? The first step is identifying the concrete skills that we need to teach them. Here we will zoom in on the sub-skills needed for your child or teen to check their BG and take action based on the result - safely, effectively and independently. Why not pick one now and work toward its mastery?

Here is a list of sub-skills that are involved with checking blood sugar and acting on the result. Ask yourself if your child/teen can – and will – independently do all of the following tasks. If you answered “no” to a certain step, that could become a teaching target to move your child towards independence.

Skills Involved in Checking and Treating Blood Sugar:

  1. The Physical Process - Fingerstick Blood Glucose Check:

      1. Washes hands.
      2. Finds and opens the blood glucose monitor kit.
      3. Takes the monitor out of the case.
      4. Takes the strip out of the container and closes the lid.
      5. Puts the strip in the monitor.
      6. Takes the lancing device out of the case.
      7. Preps the lancing device by pulling the spring back.
      8. Chooses an appropriate test spot. (Which finger or toe will be effective? not over-used?)
      9. Pricks the finger/toe:
        1. Firmly places the lancing device against the skin.
        2. Pushes the button.
        3. Milks the finger or toe (if needed) until blood drop is big enough.
      10. Puts the strip next to the drop of blood to draw the blood into the strip.
      11. Reads the resulting number accurately.
      12. Determines if that number is: “within target”, “high”, or “low”.
      13. Knows what to do next for blood glucose reading that is:
        1. In range (no extra care needed).
        2. Low.
        3. High.
      14. throws away the used test strip
      15. Puts the monitor back in its case, and the case back in the place where it is stored.
      16. Replaces lancet when necessary:
        1. Knows when to replace lancet. (ex. before each check; morning + evening; daily)
        2. Decides if lancet needs to be replaced at this time.
        3. Replaces used lancet with new one, if needed.
          1. Removes lancet case cover.
          2. Removes used lancet.
          3. Disposes used lancet in sharps container.
          4. Inserts new lancet.
          5. Removes protective cover from new lancet.
          6. Replaces lancet case cover.
  2. Using a sensor-based Glucose Monitor (CGM or Libre):

      1. Navigates device to find current glucose reading
      2. Determines if that number is: “within target”, “high”, or “low”.
      3. Identifies current trend (glucose is steady, rising, or falling).
      4. Knows how to respond to a blood glucose reading that is: In range, below target, or above target, with the current glucose trend in mind. (For example, you may choose to do nothing if sensor glucose is in-range and steady, however... you may choose instead to eat a snack if glucose is in-range but falling rapidly, or you may choose to deliver a correction dose of insulin if glucose is above-range and rising.)
  3. Treating Lows:

      1. Identifies:
        1. that a blood glucose reading below 4.0 mmol/L is low, OR
        2. that he is experiencing signs and symptoms of low blood glucose; checks blood glucose to confirm or rule-out.
      2. Decides on an effective source of fast-acting sugar.
      3. Determines how much is needed to treat the low.
      4. Consumes all of the low treatment.
      5. Remembers to re-check blood glucose 15-20 minutes later.
        1. After the re-check, decides if another low treatment is needed. (That is, blood glucose still below 4.0 mmol/L.)
        2. If yes, repeats the process.
      6. Decides if a supplementary carb/protein snack is needed.
        1. If yes, follows through with an appropriate snack.
      7. Preps pre-measured treatments for future use. (For example, puts 10 skittles in a mini baggie or empty test strip bottle, so that 10g low treatment is ready to go the next time BG is low.)
  4. Treating Highs:

    1. Detects signs and symptoms of high blood glucose; completes a blood glucose check (as above).
    2. Identifies that a correction is needed when the blood glucose reading is above the target range.
    3. Identifies the need to check for ketones if blood glucose greater than 14.0 mmol/L.
    4. Decides how much rapid insulin is needed for the correction, by:
      1. If using injections: Properly using the “sliding scale”, correction formula or correction factor and adding this to the meal rapid insulin (if it’s mealtime).
      2. If using an insulin pump: correctly interpreting insulin dosing recommendations.

The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.