Blood glucose monitoring

Type 1 diabetes mellitus

NICE NG17 and NICE NG18 recommend that all adults, children and young people with type 1 diabetes should be offered a real-time continuous glucose monitor (rtCGM) device to monitor their glucose levels.

For further information, including the local commissioning position, refer to section 6.1.7 Continuous Glucose Monitors (CGM)

NICE advises that people with type 1 diabetes who are using CGM will still need to take capillary blood glucose measurements (although they can do this less often), because:

• they will need to use capillary blood glucose measurements to check the accuracy of their CGM device
• they will need capillary blood glucose monitoring as a back-up (for example, when their blood glucose levels are changing quickly or if the device stops working).

Provide them with enough test strips to take capillary blood glucose measurements as needed.

If a person cannot use or does not want a real-time continuous glucose monitor (rtCGM) or intermittently scanned continuous glucose monitor (isCGM), offer capillary blood glucose monitoring.

Self-monitoring of blood glucose

NICE NG17: Type 1 diabetes in adults: diagnosis and management recommends supporting adults with type 1 diabetes to test blood glucose at least 4 times a day, and up to 10 times a day if any of the following apply:

• the desired target for blood glucose control, measured by HbA1c level, is not achieved
• the frequency of hypoglycaemic episodes increases
• there is a legal requirement to do so (such as before driving, in line with DVLA guidance on the medical standards of fitness to drive)
• during periods of illness
• before, during and after sport
• when planning pregnancy, during pregnancy and while breastfeeding (see the NICE guideline on diabetes in pregnancy)
• if there is a need to know blood glucose levels more than 4 times a day for other reasons (for example, impaired awareness of hypoglycaemia, high-risk activities).

Enable additional blood glucose testing (more than 10 times a day) for adults with type 1 diabetes if this is necessary because of the person's lifestyle (for example, driving for a long period of time, undertaking high‑risk activity or occupation, travel) or if the person has impaired awareness of hypoglycaemia.

Type 2 diabetes mellitus

NICE has issued a “Do not do” recommendation in relation to self-monitoring of blood glucose (SMBG) by people with type 2 diabetes. The exceptions to this recommendation are listed below.

NICE guidance recommends that SMBG should not be offered to people with type 2 diabetes unless:

• the person is on insulin or
• there is evidence of hypoglycaemic episodes or
• the person is on oral medication that may increase their risk of hypoglycaemia while driving or operating machinery (see DVLA guidance) or
• the person is pregnant, or is planning to become pregnant (see the NICE guideline on diabetes in pregnancy)

A structured review of self-monitoring in type 2 diabetics should be carried out at least annually.

Short term monitoring should be considered when starting treatment with oral or intravenous steroids or to confirm suspected hypoglycaemia.

NICE NG28 recommends that a small defined group of adult patients with type 2 diabetes who are treated with insulin should be offered intermittently scanned CGM (isCGM). For further information including the local commissioning position, refer to section 6.1.7 Continuous Glucose Monitors (CGM)

Meter / Strips / Lancets

For patients testing blood glucose

All the following first line meters are suitable for use in type 1 and type 2 diabetes (where indicated).

GlucoMen Glucofix Tech meter (Menarini)

• Strips: GlucoMen Glucofix Tech Sensors test strips (£5.95 = 50 strips)
• Expiry of strips: 12 months after opening
• Manufacturer contact number/patient care line: 0800 243 667
• Recommended lancets: Glucoject Lancets PLUS 0.2mm/33G (£5.50 = 200 lancets)
• Alternative lancets: Gluco-Rx Lancets 0.31mm/30G (£4.50 = 200 lancets) supplied with lancing device

Accu-Chek Instant meter (Roche)

• Strips: Accu-Chek Instant test strips (£5.95 = 50 strips)
• Expiry of strips: unaffected by opening – as per date on pack
• Manufacturer contact number/patient care line: 0800 701 000
• Recommended lancets: Accu-Chek FastClix Lancets 0.3mm/30G (£5.90 = 204 lancets)
• Alternative lancets: Gluco-Rx Lancets 0.31mm/30G (£4.50 = 200 lancets) supplied with lancing device

AgaMatrix WaveSense JAZZ (AgaMatrix)

• Strips: AgaMatrix WaveSense JAZZ DUO test strips (£8.74 = 2 x 25 strips)
• Expiry of strips: 12 months (6 months after opening each pot)
• Manufacturer contact number/patient care line: 0800 093 1812
• Recommended lancet: AgaMatrix Ultra-Thin Lancets 0.2mm/33G (£5.43 = 200 lancets)
• Alternative lancets: Gluco-Rx Lancets 0.31mm/30G (£4.50 = 200 lancets) supplied with lancing device

For patients who are carbohydrate counting or insulin pump users

These will be patients with Type 1 diabetes who have received structured education from the local Diabetes Specialist Team.

Primary Care will be advised by the Specialist Team regarding which blood glucose test strip to prescribe for these specific patients.

For patients who are carbohydrate counting, in most cases, a first line formulary choice meter and supporting app, will meet the needs of the patient.

For insulin pump users, some insulin pumps require specific meters, whereas others are not so prescriptive. Whenever possible, a first line formulary choice meter will be selected by the specialist.

However, there maybe be times when a first line formulary choice meter is not suitable. In these cases, primary care is asked to prescribe the corresponding strips as requested by the specialist to support ongoing patient testing. Specialists are expected to explain to the GP the reason that formulary recommended options are not suitable.

For patients who need to test for blood ketones:

With the advancements in technology of strips, testing blood ketones with capillary blood is much more accurate than testing urine for ketones. Type 1 patients who have unstable diabetes control and have a significant risk of developing ketones (after specialist advice) may benefit from testing their blood for ketones once their glucose level reaches an agreed upper limit and/or in times of acute illness. It is also recommended by NICE for all pregnant women with type 1 diabetes and advised for all those on insulin pump therapy.

MHRA Drug Safety Update (March 2020): SGLT2 inhibitors: monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness

• interrupt sodium-glucose co-transporter 2 (SGLT2) inhibitor treatment in patients who are hospitalised for major surgical procedures or acute serious medical illnesses
• monitor ketones during this period – measurement of blood ketone levels is preferred to urine
• restart treatment with the SGLT2 inhibitor once ketone values are normal and the patient's condition has stabilised

GlucoMen Areo 2K meter (Menarini)

• Strips: GlucoMen Areo Ketone Sensors test strips (£9.95 = 10 strips)
• Expiry of strips: unaffected by opening – as per date on pack
• Manufacturer contact number/patient care line: 0800 243 667
• Recommended lancets: Glucoject Lancets PLUS 0.2mm/33G (£5.50 = 200 lancets)
• Alternative lancets: Gluco-Rx Lancets 0.31mm/30G (£4.50 = 200 lancets) supplied with lancing device

GlucoRx HCT meter (GlucoRx Ltd)

• Strips: GlucoRx HCT Ketone test strips (£9.95 = 10 strips)
• Expiry of strips: unaffected by opening – as per date on pack
• Manufacturer contact number/patient care line: 0800 007 5892
• Recommended lancets: Gluco-Rx Lancets 0.31mm/30G (£4.50 = 200 lancets)

For paediatric use only

Freestyle Optium Neo meter is for paediatric use only, where GlucoMen Areo 2K meter or GlucoRx HCT meter is considered not to meet the needs of the child

When transitioning to adulthood, the patient’s meter should be switched to GlucoMen Areo 2K meter or GlucoRx HCT meter for ketone testing

FreeStyle Optium Neo meter (Abbott)

• Strips: FreeStyle Optium β-ketone test strips (£21.94 = 10 strips)
• Expiry of strips: unaffected by opening – as per date on pack
• Manufacturer contact number/patient care line: 0800 612 3006
• Recommended lancets: Gluco-Rx Lancets 0.31mm/30G (£4.50 = 200 lancets) supplied with lancing device. NB these are not the lancets included in the meter pack

Oral glucose tolerance test

Glucose Tolerance Test

• Solution 75g in 200ml