Potential Difficulties in HBGM Procedure

Although HBGM is desirable, there are several well-recognized potential difficulties connected with the procedure.

• A finger-prick blood sample must be obtained for each test and people may find this uncomfortable and unpleasant, especially because it has to be carried out on a regular daily basis. Someone newly receiving insulin treatment may be asked to perform four tests a day but usually, the number can be reduced once a pattern of readings has emerged.
• Blood glucose levels are assessed by using enzyme-impregnated strips or sticks which are available free on prescription. These can either be 'read' visually by matching the colour on the strip to a chart, or else with the aid of a specially designed meter. There are more than 12 types of meter available, some with large print displays or an audio output for people with sight or hearing difficulties. However, meters are not available on prescription and must be bought by the patient. Costs vary considerably, depending upon the sophistication of the meter and the facilities it provides, such as memory and the ability to link with a computer. People sometimes think that they need to buy an expensive, elaborate meter, when in fact a much more simple device would equally suit their needs. Clinical staff are always happy to advise about meters and have first-hand experience of the different types that are available. Some clinics make their own arrangements and can provide meters free of charge, at least to some of their clients. The people most likely to benefit would be those newly diagnosed with Type 1 diabetes. Meters vary in their operational instructions, which must always be followed meticulously. Each meter will use a particular type of test strip. Although training in the use of meters is given at diabetes clinics, some people find the equipment difficult to use when on their own at home.
• Specially designed, very fine blades or needles known as lancets are available free on prescription for HBGM. Like insulin needles, after they have been used, these must be placed in a container with a lid and disposed of safely, in accordance with local arrangements and advice given by the diabetes clinic. Hand-held devices are available which can be pre-loaded with a lancet. When held against the side of a finger and triggered, the point of the lancet shoots into the surface of the skin making a pin-prick and making it easier to obtain a drop of blood. These devices are not available on general prescription, although some clinics may make their own arrangements and be able to provide them for some of their patients. Whatever the method used, many people find finger-pricking the most difficult part of carrying out HBGM and some find it so unpleasant that they do not test for blood glucose as often as they should.
• Obtaining accurate results from HBGM depends upon attentiveness at all stages of the procedure, from obtaining a 'clean' drop of blood to correct use and storage of test strips, meters and charts. Once obtained, each reading must also be noted in a 'monitoring diary' provided by the clinic. It is known that errors can easily be introduced at any stage, with potentially serious consequences if the end result is an inappropriate alteration of an insulin dose.
• Some people, understandably, feel that HBGM is one task too many on top of the daily necessity of having to self-inject insulin. It is not uncommon for there to be major discrepancies between the results presented by the patient and those (based on glycated haemoglobin obtained by the clinic. As noted above, people may test too infrequently and then, as a clinical appointment approaches, be tempted to invent good results! The only way around this is if the patient can learn to appreciate the benefit to his or her own health of regular HBGM.
• People suffering from physical or intellectual impairment, mental illness or depression, and young children may need extra help and encouragement with HBGM. It is likely that family and/or carers will need to be involved, as they probably are already with insulin injections. Carers and families can feel a considerable burden of responsibility in performing these tasks, which also impinge upon their own freedom, tying them to the routine of the person with diabetes. All this requires understanding, help and support and a good relationship with diabetes clinical staff so that problems can be discussed openly. In the same way, the physically disabled person with diabetes may feel frustrated about not being able to manage HBGM and insulin injections and may struggle with his or her dependency.

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