Blood sugar measurement errors in children and ways to prevent them
Measuring blood sugar in children with diabetes (type 1 or 2) is a vital part of managing their disease. But sometimes measurement errors may cause incorrect values to be displayed, which can lead to incorrect insulin or medication dosage adjustments. These errors occur for various reasons, which we will examine below.
1. Errors related to the measuring device (glucometer)
. Incorrect calibration of the device:
Some glucometer devices require initial settings and calibration based on the test strip used. If this is not done, the results may be inaccurate.
It is recommended to test the device with the specific glucose control solution of that brand to ensure its accuracy.
. Using expired test strips:
Blood sugar test strips have an expiration date, and if expired strips are used, the results may be inaccurate.
Always check the expiration date of the strips and store them in a dry environment away from direct light.
. Damage or contamination of the glucometer:
Contamination, grease, dust or the presence of chemicals on the device’s sensor lens can cause errors in blood sugar readings.
It is recommended to clean the device periodically with a dry, alcohol-free tissue.
2. Errors related to the sampling method
. Failure to wash hands before testing:
If the child’s hands are contaminated with food, sweets or other substances, the displayed sugar level may be higher than the actual level.
It is recommended to wash hands with soap and water and dry them completely before taking the sample.
. Excessive pressure on the finger when taking the sample:
Excessive pressure on the finger may cause intercellular fluid to enter the blood sample and cause an inaccurate decrease in the measured blood sugar level.
It is better to use a lancet (special needle) with the appropriate depth so that the blood comes out of the fingertip naturally.
. Using an inappropriate site for sampling:
Some devices are sensitive to blood samples from different parts of the body, such as the arm or thigh, but the blood sugar level in these places may be different from the fingertip blood sugar.
For a more accurate measurement, sampling from the fingertip is usually recommended.
3. Environmental errors and the child’s conditions
. Ambient temperature and humidity:
If the glucometer device is placed in very high or low temperatures (for example, inside a car in summer or winter), it may show incorrect results.
Store the test strips at the appropriate temperature and away from direct sunlight.
. Child dehydration (dehydration):
In conditions where the child is dehydrated (for example, due to diarrhea, vomiting, or excessive sweating), the blood sugar level may be displayed falsely high or low.
In such situations, it is necessary to adjust the child’s fluid intake and, if severe dehydration is suspected, a venous blood test should be performed.
. Severe blood sugar fluctuations during stress or illness:
When a child has an infection, stress, fever, or viral illness, blood sugar levels may fluctuate suddenly.
In these situations, it is better to measure blood sugar at shorter intervals to better determine the process of changes.
4. Compare glucometer results with laboratory results
Sometimes parents notice a discrepancy between the results measured at home and the laboratory results. For a more detailed check:
. Compare the glucometer results with the venous blood test in the laboratory to assess the accuracy of the device.
. If the difference is more than 15 to 20 percent, the problem may be with the device, the test strip, or the sampling method.
. Some glucometer devices have inherent error and should be used with certified and highly accurate models.
5. Strategies to reduce blood sugar measurement errors in children
1. Wash and dry the child’s hands before testing
2. Use authentic test strips and store them properly
3. Avoid squeezing the finger too much when sampling
4. Regularly check the device’s calibration and compare with laboratory tests
5. Use standard devices approved by health organizations
6. If abnormal fluctuations are observed, recheck with another device or see a doctor
Summary
Measuring blood sugar in children is an important part of diabetes management, but various errors can affect the accuracy of the results. Errors related to the glucometer, test strips, sampling method, environmental conditions, and the child’s physical condition can cause incorrect results. To prevent these errors, it is recommended to follow the correct measurement principles, use authentic devices, and compare occasionally with laboratory results.
6. The effect of medications and nutrition on the accuracy of blood sugar measurement
Some medications and foods may cause errors in blood sugar measurement. These effects can appear as falsely high or low blood sugar readings on glucometers.
. Medications that may falsely alter blood sugar:
Vitamin C (high doses): Taking large amounts of vitamin C supplements can make blood sugar levels appear lower than they actually are.
Acetaminophen (paracetamol): Some glucometers may show unrealistically high blood sugar readings when taking acetaminophen.
Antidepressants and corticosteroids: These medications can increase blood sugar and cause fluctuations in the measured value.
. Foods and drinks that affect measurement accuracy:
Sweet drinks: If the child’s hands are contaminated with sugary substances such as fruit juice or chocolate before the measurement, the blood sugar level will be displayed higher than the actual level.
Fatty foods: High-fat foods (such as fast food) can slow down the absorption of glucose, causing blood sugar to rise suddenly after a few hours and making initial measurements lower than the actual level.
7. How to deal with abnormal results in blood sugar measurement
In some cases, the measurement results may be unreasonable or unexpected. In these situations, take the following steps:
. Recheck the measurement:
If the blood sugar level is displayed too high or low, wash the child’s hands and perform the test again.
Use a new test strip and calibrated device.
. Comparison with clinical symptoms:
If blood sugar is too low (hypoglycemia) or too high (hyperglycemia) but the child has no specific symptoms, the result may be incorrect and needs to be repeated.
If there are symptoms such as dizziness, weakness, palpitations or extreme thirst, especially if the measurement result is abnormal, immediate action should be taken.
. Using alternative methods to confirm the result:
If you doubt the results of the glucometer, you can measure blood sugar with another device.
If abnormal results are repeated, it is better to request a venous blood test (FBS or HbA1c) from the laboratory.
. Visiting a doctor in an emergency:
If the blood sugar level is more than 250-300 mg/dL and the child has symptoms of diabetic ketoacidosis such as nausea, vomiting, deep breathing or the smell of acetone on the breath, you should go to the hospital immediately.
If the blood sugar level is below 70 mg/dL and the child has symptoms of hypoglycemia, they should be given a quick source of sugar, such as juice or glucose, and then their blood sugar should be measured again.
8. New technologies to reduce blood sugar measurement error
. Continuous glucose monitoring (CGM) devices:
These devices measure blood sugar continuously by placing a sensor under the skin, reducing the possibility of errors caused by manual sampling.
Popular brands such as Dexcom, FreeStyle Libre, and Medtronic offer this technology.
. Devices that do not require blood sampling:
Some new devices measure blood sugar through optical sensors on the skin or through intercellular fluids.
This technology is still in the development stage but could increase the accuracy of measurements in the future.
. Mobile apps for blood sugar management:
Some mobile apps can connect to a glucometer and automatically record results and can analyze blood sugar changes.
These apps help patients and doctors better understand blood sugar patterns and take appropriate action.
Final summary
. Blood sugar measurement errors in children can occur for various reasons, such as problems with the glucometer, test strips, sampling method, environmental conditions, and the use of certain medications.
. To reduce these errors, the device should be properly maintained and calibrated, the child’s hands should be washed before measuring, and abnormal results should be confirmed by repeating the test or laboratory tests.
. New technologies such as continuous glucose monitoring (CGM) devices and non-invasive devices can improve measurement accuracy in the future.
9. The effect of certain medical conditions on blood sugar measurement results in children
Some diseases and certain medical conditions can cause changes in blood sugar measurement results. These conditions may show results falsely high or low and make it difficult to manage your child’s diabetes. We will examine these factors below.
. Diseases that can affect the accuracy of blood sugar measurement:
1. Anemia and blood disorders
In children with iron deficiency anemia, the glucometer may show blood sugar levels slightly higher than they actually are.
In contrast, in diseases such as thalassemia or sickle cell anemia, the results may fluctuate abnormally.
For a more accurate examination in these cases, it is better to perform the HbA1c test along with venous blood sugar.
2. Kidney diseases
Poor kidney function can affect the accuracy of blood sugar test strips, because waste products from the blood may cause an incorrect chemical reaction in the test strip.
In children with kidney failure, the glucometer results may be lower than the actual value.
3. Thyroid problems
Hypothyroidism can cause metabolism to slow down and blood sugar to slightly increase.
Hyperthyroidism may cause blood sugar to fluctuate and increase suddenly.
4. Liver diseases and their effect on blood sugar results
Liver diseases (such as hepatitis or fatty liver) can cause abnormally high blood sugar.
In some cases, the liver’s poor function in producing and regulating glucose can cause sudden low blood sugar (hypoglycemia).
5. Severe infections and physical stress
During illnesses such as colds, flu, or severe infections, stress hormones such as cortisol and adrenaline cause blood sugar to increase.
For this reason, blood sugar should be monitored more closely than usual in these situations to prevent complications.
10. Recommendations to increase the accuracy of blood sugar measurement in children
1. Always wash and dry the child’s hands before measuring.
2. Use valid and dated test strips.
3. Calibrate the glucometer regularly.
4. Recheck unexpected results.
5. If you see unusual differences, use a venous blood test in the laboratory.
6. Check blood sugar more frequently during certain illnesses.
7. Use new technologies such as continuous glucose monitoring (CGM) devices.
Summary
. Accurate blood sugar measurement in children is of great importance, but some diseases and environmental factors can cause errors in the results.
. Using accurate devices, correct sampling methods, and understanding the impact of specific medical conditions can help better manage diabetes in children.
. If you see severe fluctuations or unusual results, it is best to consult an endocrinologist.
11. New methods for more accurate blood sugar control and monitoring in children
With the advancement of technology, new tools have been developed to continuously monitor blood sugar and reduce measurement errors. These methods help parents and doctors to better control the blood sugar of diabetic children and prevent possible complications.
1. Continuous Glucose Monitoring (CGM) devices
Continuous Glucose Monitoring (CGM) systems continuously measure blood sugar levels and provide accurate information about its fluctuations. These devices include a small subcutaneous sensor that measures glucose levels every few minutes and displays the results on a mobile phone or receiver.
. Benefits of using CGM:
Continuous monitoring without the need for frequent blood draws
Reduces the risk of sudden drops or rises in blood sugar
Smart alerts to prevent hypoglycemia and hyperglycemia
Ability to send data to your doctor and parents for better diabetes management
. Popular CGM brands:
Dexcom G6 and G7 (equipped with smart alerts)
FreeStyle Libre 2 and 3 (no need to draw blood from your fingertip)
Medtronic Guardian Connect (can be connected to an insulin pump)
2. Smart insulin pump
Insulin pumps automatically calculate and inject the amount of insulin the body needs based on blood sugar levels. These pumps can connect to CGM devices and create an automatic system for regulating blood sugar.
. Benefits of an insulin pump:
More accurate insulin delivery and reduced human error
Reduced need for daily injections
Improved blood sugar control overnight and after meals
Reduced risk of sudden blood sugar drops
. Commonly used insulin pumps:
Medtronic MiniMed 780G (connected to CGM for smart insulin regulation)
Omnipod DASH (no tubes or wires required)
Tandem t: slim X2 (with predictive blood sugar changes)
3. Smart apps for managing diabetes in children
Smart apps can help parents easily monitor their child’s blood sugar, insulin levels, nutrition, and physical activity. Some of these apps are compatible with CGM devices and insulin pumps.
. Useful apps for diabetes management:
MySugr: Record and analyze blood sugar levels, carbohydrate intake, and insulin
Glooko: Sync with CGM devices and insulin pumps
BlueLoop: Suitable for children and families who need easy diabetes management
4. Non-invasive devices for measuring blood sugar
New technologies are being developed that measure blood sugar without the need to pierce the skin or draw blood from a fingertip. These devices usually use infrared technology or electrochemical sensors to measure glucose levels.
. Some non-invasive devices in development:
SugarBEAT: Blood sugar measurement via skin patch
GlucoTrack: Uses infrared technology to measure blood sugar via the earlobe
Apple Watch (next generation): Checking blood glucose via optical sensors
12. The role of nutrition in reducing blood sugar fluctuations in children
Nutrition plays a key role in preventing blood sugar fluctuations. Parents should adjust the child’s diet in a way that prevents sudden increases or decreases in sugar.
. Important nutritional tips for blood sugar control:
Consuming foods with a low glycemic index such as oats, lentils, and vegetables
Avoiding excessive consumption of simple sugars such as industrial fruit juices and sweets
Using protein and fiber to reduce the rapid absorption of sugars
Adjusting meals and snacks to prevent low blood sugar
13. Final summary and recommendations
. To better control blood sugar in children, new technologies such as CGM, insulin pumps, and smart apps can be used.
. In the future, non-invasive devices can replace traditional glucometers and create a more comfortable experience for children.
. Following a proper diet and meal planning play an important role in controlling diabetes.