When a person has diabetes, wounds can take longer to heal. High blood glucose affects both the immune system and the circulation. If the latter is not efficient, then nutrients aren’t delivered to the wound to promote repair of tissue. 

Wounds on the feet and legs impact on mobility. There is a risk that a minor cut or abrasion can develop into a larger ulcer and even affect bone. Osteomyelitis (infection of bone) is a serious condition requiring hospitalisation. Chronic (present for more than three months), poorly healing ulcers are painful and stressful to manage. The worst outcome is amputation, but good wound management should always prevent this.

Initial assessment of any wound on the feet should ideally be with your podiatrist, but if there is none available then please see your doctor. It may be necessary to send you to a specialist wound clinic and there is no doubt that over the long-term you’ll see better and quicker healing with less complications, such as the formation of excess scar tissue.

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Glucose, the simplest of all sugars, enters the bloodstream from two main sources: food and drink consumed and the liver. Your blood glucose levels will fluctuate throughout the day. There are various ways that you can measure your blood glucose.

Finger-prick measurement using a glucometer. This is how you find out what your blood glucose level is at that moment in time. It’s a snapshot. You’ll need these things to do the measurement:

1. A glucometer (glucose monitor). There are several brands on the market so it might be best to ask your healthcare team for advice on a glucometer that will suit you. Some have a larger display for people with impaired sight and others have sophisticated technology allowing you to upload glucose readings to a smartphone or computer. Remember many medical practices will be able to supply a glucometer free of charge. Always make sure that you get the correct strips to match the glucometer you’re using.

2. A finger-prick or lancing device which comes with the glucometer. These pierce the skin with a needle (lancet) so that a drop of blood can be taken for measurement. The depth of piercing can be adjusted by dialling numbers 1 to 5, with 1 being a very shallow and 5 the deepest. The thickness of your skin will determine what number to set. There is no set time to change the lancets but if pricking your finger becomes particularly painful then a new lancet is indicated. People with diabetes soon work out how often they prefer to change the lancet. To change the lancet, remove the cap from your finger-prick device and put in a new lancet usually by twisting and pushing in. Then put the cap back on. 

3. Glucose strips. These strips usually come in batches of 50 and must work with the type of meter you’ve chosen.

How to measure your blood glucose

• Wash your hands with soap and warm water. Don’t use wet wipes or sanitiser as products in them can affect the result. Ensure your hands are warm so it’s easier to get blood thus reducing discomfort.

• Take a strip, keeping the side with the bar code facing up, slot the barcode   end into the glucometer. 

• The glucometer will now switch on and a display, usually a flashing drop of blood, will indicate it’s ready for the test.

• Load the plunger of the pricking device by pulling the top of it backwards until a click is heard.

• Choose which finger to prick but avoid your thumb and index finger. Try not to prick the middle of the finger pad, or too close to a nail. Place the flat end of the device against the side of your finger and press the release button (often white or yellow). Use a different finger or area of the finger for the next measurement.

• Take your meter with the strip and hold it against the drop of blood. It will tell you if the strip is filled, usually by beeping. 

• Before you look at your reading, check your finger. Use a tissue to stop bleeding if necessary. If you get the depth of prick correct, then often there will be very little blood to wipe away.

• Most meters show the result in five seconds. Usually, they have a memory you can access but if you’re keeping a diary then note it down.

• You can use the same tissue to take  out the strip and throw that away too.    

• Taking out the strip will usually turn the meter off.

• If you’re still unsure then google your device, and invariably there will be a website, or video explaining. This is useful for resetting the time and date on the glucometer.

Electronic blood glucose monitor, called a flash glucose monitor or continuous glucose monitor (CGM).These devices don’t require regular skin pricking or needles. Instead, they use a sensor inserted into your skin. They measure the amount of sugar in the fluid surrounding your cells, called interstitial fluid rather than blood glucose. There will always be a lag between interstitial fluid glucose and blood glucose so they may not match exactly. Most CGM devices are so accurate that they don’t need to be calibrated against a finger-prick measurement. The CGM transmits the measurements to a reader or smartphone. 

Know your body and how it works

Measuring your blood glucose should always be done with a purpose. This can be to assess the effect of medication, including insulin, on your blood glucose. It’s also valuable to know what food, exercise, and other life events, such as illness, can do to your blood glucose.

To see how food affects your blood glucose, it’s best to measure before and two hours after a meal. This can be recorded in your machine to be downloaded later, or in a diary. Some meters are linked to apps which allow you to see the readings on your smartphone.  Alternatively, there are also diabetes apps you can manually enter your reading into and then see them in the form of graphs or tables.

The most important reason to check your blood glucose is to have information that will continue to improve your control. Your diabetes team will continue to help in the decision-making process, but it’s also valuable to keep learning how to act on blood glucose readings. 

How often should you test

This depends mainly on your current diabetes control and the type of treatment you’re receiving. As a rule, people on oral medications should measure about three times a week. Patients using insulin should measure as often as they inject. This means a person taking one long-acting insulin injection daily should check their fasting blood glucose daily. A person injecting a mixed insulin twice daily should measure before each injection, so two readings daily. Similarly, a person using a basal bolus regimen of one long-acting insulin daily 

and short-acting insulin before meals should check before each injection and before bed: four readings daily. However, there are people who check many times more than this, especially if using a CGM.

TARGETS FOR GLUCOSE CONTROL

	HbA1c	Fasting blood glucose mmol/L	Two-hour post meal blood glucose mmol/L
YOUNG	< 6,5%	4 – 7	4,4 – 7,8
MOST	< 7,0%	4 – 7	5 – 10
ELDERLY	< 7,5%	4 – 7	< 12

Low blood glucose

If your blood glucose is too low, usually below 4 mmol/L, you may experience  hypoglycaemia. These need to be treated immediately by consuming quick-acting sugar, otherwise your blood glucose will drop further. If this happens, you may experience a severe hypo and need emergency treatment. Your healthcare team will advise on the amounts and types of sugar that can be used.

High blood glucose

The level at which symptoms begins to appear is different for everyone, but the common ones include passing more urine than normal, being very thirsty, having headaches and feeling tired and lethargic.

For people using insulin, a ketone test should be done if there is persistent or unexpected high readings. Ketones are acids produced when the body breaks down fat stores. The presence of ketones indicates a shortage of insulin, and is dangerous causing nausea, vomiting, dehydration and coma. People using insulin should be educated on how to manage ketones. However, if you have ketones always contact your healthcare team or go to the nearest emergency room.

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A healthy, balanced diet is integral to the holistic management of your diabetes. Diabetes doesn’t mean you can’t eat; it simply means to eat right. 

Of all the things that make blood glucose levels rise, food plays the biggest role. Some foods can raise your blood glucose more than others and portion size plays a significant role too. The same foods can have different effects on blood glucose in different people. It’s important to learn what your individual response is and have some control of your diet.

Although it’s helpful to have an individualised eating plan to help with your diabetes, there are basic concepts that are common to everyone. All food can raise blood glucose, but the different macronutrients have different effects. 

1. Carbohydrates, which includes all sugars and starches, raise blood glucose the fastest. For this reason, this is the food group you should have most knowledge about. 

The glycaemic index is a measure of how much a particular carbohydrate is likely to increase the blood glucose by. High-GI foods (white flour, refined cereals, etc.) cause immediate spikes in blood glucose. Low-GI foods slowly increase blood glucose and avoid spikes. Portion plays an important role as higher portions will usually cause higher levels of blood glucose after meals. Hence why you should know the carbohydrate content in various foods to make the right choices. Discuss with your dietitian the right amount of carbohydrates to keep track of the amount eaten and set a limit. 

2. Protein, animal or plant-based, has a minimal effect on blood glucose as long as there is sufficient insulin working in the body. Protein helps a person to feel full which can decrease snacking.

3. Fat has little direct effect onblood glucose, but excess amounts contribute to weight gain and insulin resistance which in turn worsens diabetes control.

A balanced diet must be planned to support a healthy weight and get blood glucose levels to target. These levels can change throughout the day and are affected not only by food but also activity and medication. Measuring your blood glucose levels before and after your meals helps see the immediate effect of your food choices and portions on your blood glucose. This post-meal measurement must be done at two hours after. Glucose levels peak from 1 ½ to two hours after a meal. International and national guidelines have standardised post-meal targets at two hours. 

Self-monitoring of blood glucose chart

A chart to document self-monitoring of blood glucose, also referred to as a diabetes diary, is an important tool in diabetes management. It helps you and your doctor assess the effect of medication as well as to evaluate your meal choices.

For example, if your two-hour post-meal glucose is more than 3mmol/L higher than your before-meal glucose, next time you could eat a smaller portion of carbohydrates.  

You can use apps to measure and monitor dietary intake or speak to your dietitian or diabetes educator for a list of carbohydrates in common foods and use food labels to calculate and record your carbohydrate intake so that you can identify how many carbohydrates are ideal for you.

TARGETS FOR GLUCOSE CONTROL

	HbA1c	Fasting blood glucose mmol/L	Two-hour post meal blood glucose mmol/L
YOUNG	< 6,5%	4 – 7	4,4 – 7,8
MOST	< 7,0%	4 – 7	5 – 10
ELDERLY	< 7,5%	4 – 7	< 12

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