Currently, 11.7 million Canadians live with diabetes or prediabetes and this number is steadily rising.1 Diabetes is a chronic condition in which there is an elevated amount of sugar in the blood (i.e. hyperglycemia). There are four main types of diabetes: Type 1, Type 2, drug-induced and gestational diabetes. Individuals with Type 1 are not able to produce insulin and require daily insulin injections.2 Type 2 diabetes is characterized by insufficient insulin production and/or insulin resistance.2 Gestational diabetes is glucose intolerance that is first detected or begins during the 2nd or 3rd trimester of pregnancy, often resolving after the patient has given birth.2 An essential part of managing diabetes is getting blood sugar levels under control to prevent diabetes-related complications such as cardiovascular disease, neuropathy, nephropathy, and retinopathy.2,3,4
A critical tool in the management of diabetes is self-monitoring of blood glucose (SMBG). Self-monitoring of capillary blood glucose (SMBG) allows individuals to measure their blood sugar at home, empowering patients to manage their diabetes more effectively. It also provides valuable information to health care professionals by providing real-time data to influence medication selection, alert patients to hypoglycemia, and inspire lifestyle modifications to help diabetic patients achieve their A1C goal.
Although the clinical utility of SMBG is well established, many patients may be unfamiliar with the nuances of capillary blood glucose testing. The pharmacy team can play an integral role in counselling patients on evidence-based SBMG strategies, including testing targets and frequency.
Helping Patients Achieve their Blood Glucose Targets
SMBG targets can vary depending on whether someone is achieving their target HbA1C and/or age.2 For most individuals that are at an HbA1C of 7%, fasting plasma glucose readings should be between 4-7 mmol/L and the 2-hour post-prandial target is 5-10 mmol/L.2 SMBG, along with structured educational programs, can help facilitate behavioural changes that result in better management of diabetes.2,3,4
The frequency of monitoring blood glucose can be individualized based on several factors such as type of diabetes, medications, risk of hypoglycemia, occupational requirements and/or acute illness. 2 The Canadian Diabetes Associations recommendations for self-monitoring of blood glucose are: 2
|Diagnosis/Medications||Frequency of Monitoring|
|Insulin more than once a day||At least 3 times per day|
|Once a day|
|Type 2 diabetes, not on insulin|
For Ontario Drug Benefit (ODB) recipients there is a maximum number of blood glucose test strips allotted for a 365-day period.5 These limits are aligned with the recommendations for testing by the Canadian Diabetes Association.5 If more frequent monitoring is required (e.g. acute illness) additional test strips may be dispensed with appropriate documentation.5
Pharmacists play a key role in helping patients manage their diabetes. In addition to helping patients manage their medications, a pharmacist can help set blood glucose targets and create a plan on how to achieve these targets and educate patients on how to use a blood glucose monitor.6 Pharmacists and pharmacy technicians in Ontario can provide point-of-care testing (POCT) to assist patients with managing their medications for their chronic diseases.7 This allows for the piercing of a patient’s dermis with a lancet-type device to obtain blood for purposes beyond patient demonstration and self-monitoring of chronic diseases.7 This includes glucose and HbA1C testing. Currently, POCT performed by a pharmacy professional is not publicly funded, but OPA is working with the Ministry of Health to have this changed.7
Methods of Measuring Blood Glucose
Blood glucose monitors use a test strip that is inserted into the meter, and a sample of blood (obtained using a lancet to puncture the skin) is placed on the strip to provide a reading. Blood glucose meters measure the sugar in the blood at the time the test is conducted. Drawing blood from the fingertip is the gold standard of measurement since changes in blood glucose levels appear the most rapidly at this site. 2 Glucose monitoring has three main purposes2:
- Detect or prevent low blood sugars (i.e. hypoglycemia)
- Help health care providers and patients make dosing decisions regarding their medication (e.g. insulin)
- Evaluate how changes to diet, activity and medication impact blood sugar levels
More recent innovations for glucose monitoring include the flash and continuous glucose monitors. A flash glucose meter is a new technology that does not require finger pricking. A sensor is inserted underneath the skin and a scanner is swiped over the sensor to provide a reading. A continuous glucose monitor (CGM) provides continuous readings throughout the day.8 A sensor is inserted underneath the skin and provides readings throughout the day and alarms when blood sugar levels get too low or too high.8 It also integrates with insulin pump devices. 8 Flash and continuous glucose monitors measure glucose concentrations in the interstitial fluid.2
In addition to teaching patients how to use a blood glucose meter it is important to educate patients about2:
- How and when to perform SMBG
- The importance of monitoring results (many meters now contain electronic logbooks to record readings)
- Meaning of various BG levels
- How behavior and actions affect SMBG results
When recommending a blood glucose monitor to patients it is important to consider the accuracy, connectivity, ease of use, and support offered by the meter. An additional consideration is whether the meter allows for Second-ChanceÒ sampling, which provides the user with the ability to reapply blood when the test strip is underfilled to prevent test strip wastage.
Many meters have features such as identifying blood patterns, indicators that represent the tested value compared to a target and the ability to log medications. There are various blood glucose meters currently marketed in Canada. The Canadian industry standard has an acceptable error range of ±15% between a blood glucose meter reading and a lab reading of the same blood sample. This means that the glucose meter reading could be 15% higher or lower than the true value. Only those meters that meet the accuracy standard should be recommended.
Contour® Next meters provide readings that are ±10% from a lab reading.9 The Contour® Next family of meters is easy to use and gives results within 5 seconds. It uses smartLIGHT technology that makes it easier for the user to interpret their blood glucose level by using coloured lights that indicate if their reading is high, low or within target range.9 It also connects to the free Contour® Diabetes app which helps with self-management of diabetes by identifying trends in blood glucose results and sending notifications of potential causes.9 Additionally, the Contour® meter products allow for Second-Chance® sampling which may be an attractive feature to some patients. The Contour® Next family of meters offers 4 different meters; Contour® Next Gen, Contour® Next One, Contour® Next EZ and Contour® Next Link 2.4. All 4 meters use the Contour® Next test strips.
Selecting the appropriate blood glucose meter will be a personalized decision for each patient. Using the strategies in this article, the pharmacy team can empower patients to take control of their diabetes care through counselling on testing targets and guidelines and meter selection.
The content of this blog post was supported through a partnership with Ascensia Diabetes Care Canada.
- Diabetes in Canada: Backgrounder. Ottawa: Diabetes Canada; 2022.
- Diabetes Canada Clinical Practice Guidelines Expert Committee. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes. 2018;42(Suppl 1):S1-S325.
- Parkin, C. G., & Davidson, J. A. (2009). Value of self-monitoring blood glucose pattern analysis in improving diabetes outcomes. Journal of diabetes science and technology, 3(3), 500–508.
- Polonsky, W. H., Fisher, L., Schikman, C. H., Hinnen, D. A., Parkin, C. G., Jelsovsky, Z., Petersen, B., Schweitzer, M., & Wagner, R. S. (2011). Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes. Diabetes Care, 34(2), 262–267.
- Ontario Ministry of Health and Long-Term Care. Ontario Public Drug Programs -Frequently Asked Questions for Ontario Pharmacists: Blood Glucose Test Strip Reimbursement Policy https://www.health.gov.on.ca/en/pro/programs/drugs/teststrips/rp_pharmacists_faq.aspx#11
- Hughes, J. D., Wibowo, Y., Sunderland, B., & Hoti, K. (2017). The role of the pharmacist in the management of type 2 diabetes: current insights and future directions. Integrated pharmacy research & practice, 6, 15–27.
- Ontario Pharmacists Association. (2022, June 24). Point-of-Care Testing. https://opatoday.com/point-of-care-testing/
- Diabetes Canada. Managing your blood sugar. https://www.diabetes.ca/resources/tools—resources/managing-your-blood-sugar
- Ascensia Diabetes Care Canada Inc. Contour® Evolving with you. https://www.ascensiadiabetes.ca/diabetes-and-you/taking-control/#healthcare-team