BLOOD GLUCOSE MONITORING (Glucose check/test)

Blood glucose monitoring involves the use of test methods to determine the concentration
of glucose in the body; it helps to determine individual trend/patterns and changes in
glucose level..

Indications for glucose check

 Diabetic patient on insulin therapy Etc
 Persons with characteristic signs/symptoms of Type 1 or type 2 diabetes mellitus,
gestational diabetes, poor wound healing Etc
 Client/patient with family history of Diabetes Mellitus (part of routine health assessment
before admission)
 Client or patient with signs of Hypoglycemia (Fatigue, perspiration, confusion,
shakiness, palpitations, anxiety, lightheadedness, hunger and irritability)
 Pancreatic disorders and other related diseases
 Starvation
 Shock
 Insulin overdose

Purpose
 To obtain base line data
 For diagnostic purposes
 To determine high risk patients for diabetic complications
 As a prerequisite to commencing diabetic regimens
 To guide emergency interventions for insulin coma, diabetic coma, hyperglycemia or
hypoglycemia
 To direct or redirect pre-diabetic and diabetic management e.g guides decisions on
exercise pattern, meal types/patterns, oral anti- diabetic and insulin doses
 To determine if previous diabetic management modalities has been effective
Methods of blood glucose monitoring:
1. Glucose strip test (Glucostix); this method involves applying a drop of blood or dipping
strip in urine or into a specially prepared chemical reagent and the color change on the
strip is compared with a color chart E.g Chemostrip BG, Glucostix. This method may
require blood or urine as directed by the strip manufacturer.
2. Glucometer: E.G (Ames), Accu Check II, glucoscan 3000 (Life Scan) and one touch
(Life scan): This method involves the use of a glucometer also called a glucose meter (a
mini electronic device with a mini-monitor and a strip insertion point. The strip is
inserted in the strip holder on the glucometer, the strip sensor point is then pegged with
blood from the finger tip to determine blood glucose level which appears on the
glucometer.
3. Oral Glucose tolerance test: this method requires that the client or patients fasts for at
least 8-12 hours before the first glucose reading is taken; thereafter, a high glucose
containing drink is given (75grams), 2 hours after taking glucose drink subsequent blood
samples are taken and glucose level determined.
4. Continues Glucose Monitoring; this method requires that a sensor strip is inserted into
the patients skin around the abdomen or arm, the sensor strip determines glucose level
within the fluids in the interstitial space and transmits signals to the glucose monitor
which the patient keeps. Glucose reading is taken and transmitted every 5 minutes and
indicated on the monitor. This method determines sugar trend/pattern overnight or over a
certain period of time. The CGM unit alerts clients by beeping when blood glucose level
is above or below normal.
5. Glycated hemoglobin (HbA1c); this is a laboratory method to determine the amount of
glucose bound to hemoglobin. This method use blood samples put through certain
laboratory methods and the quantity of glucose attached to hemoglobin is determine. This
method provides insight to what the average blood glucose level has been over the last 2-
3 months.
Note: In clinical situations the following terms may be used when referring to blood glucose
tests
Fasting plasma glucose or Fasting blood sugar/glucose: blood glucose test done at
least 10-16 hours after last meal. The patient is asked to fast overnight until after blood
sugar reading is taken.
 Random plasma glucose or Random blood sugar/glucose; in this case blood glucose
test is taken at any period in time i.e at random intervals regardless of when the
individual had a meal.

RBS RANGE
 Less than 140mg/dl (7.8mmol/l) -----Normal
 Between 140 to 199 mg/dl (7.8 - 11.0 mmol/l)-----Prediabetes
 RBS above 200 mg/dl (11.1mmol/l) -------- Diabetic

FBS RANGE
 Less than (100mg/dl)-------Normal
 Between (100-125mg/dl)-----Prediabetic
 FBS above 126mg/dl (7mmol/l) taken on 2 separate occasions -------Diabetic

Requirements

A tray containing,

 Antiseptic or alcohol swab or wet swap in a galipot

 Dry cotton balls swap in a galipot

 Sterile lancet or blood-letting device

 Paper towel

 Blood glucose meter or

 Blood glucose reagent strip (specific meters have specific strips)

 Gloves
 Procedure

Action Rationale
1 Explain Action and gain consent Promotes understanding an cooperation
2 Perform hand hygiene before Action Reduces transfer of micro organisms
3 Instruct patient to perform hand hygiene with Promotes skin cleansing and vasodilatations at
soap and warm water if able selected puncture site. Hand hygiene
establishes practice for patient when test is
performed at home.
4 Position patient comfortably in a chair or in Ensure easy accessibility to puncture site.
Semi Fowler’s position
5
Apply clean gloves Reduces risk of contamination of blood
6 Remove reagent strip from the container and Protects strip in the container from Accidental
replace the cap immediately. discoloration due to exposure to air or light.
7 Check the code on the test strip Code on vial test strip must match code
entered into the glucose meter
8 Turn on glucose meter if necessary N/B: Some Activates meter
monitors are activated when the reagent strip is
inserted and therefore do not have on or off
switch.
9 Insert strip into glucose meter (Refer to Some machines must be calibrated, others
manufacturer’s directions) and make necessary require zeroing of timer. Each meter is
adjustments adjusted differently.
10 Remove unused reagent strip from meter and Moisture on strip can alter accuracy of final
place on paper towel or clean dry surface with test results.
test pad facing up (See manufacturer’s
directions).
11 Choose puncture site. Puncture site should be Ensures free flow of blood following
vascular. In adult, select lateral side of finger, puncture.
be sure to avoid central lip of fingers which has
more dense nerve supply.
12 Hold finger you will puncture in dependent Increase blood flow to area before puncture
position while gently massaging finger toward
puncture site.
13 Clean site with antiseptic swab and allow it to Alcohol can cause blood to haemolyze
dry complete
14 Remove cover of lance or blood-letting device. Cover keeps tip of lancet sterile
Hold lancet perpendicular to puncture site, and
pierce/prick finger or heel quickly in one
continuous motion (do not force lancet)
15 Some agencies use lancet devices with an Position the skin properly for the penetration
automatic blade refraction system. This reduces
the possibility of self-sticks injury and
preventing exposure to blood borne pathogens.
Place blood-letting device firmly against side of
finger and push release button, causing needle
 to pierce skin.
16 Wipe away first droplet of blood with dry cotton
ball. (See manufacturer’s direction for meter
used)
17 Lightly squeeze puncture site (without touching)
until large droplet of blood has formed. Hold
finger in dependent position before puncturing
to improve blood flow.
18 Repuncturing is necessary if large enough drop
does not form. (See manufacture’s direction on
blood application).
19 Ensure that the meter is still on. Bring test strip
in the meter e.g. ACCU-CHEK to the drop of
blood. The blood will be wicked on to the test
strip (See manufacture’s instruction).
First drop of blood may contain more serious
fluid than blood cells.
Adequate size is needed to activate monitor
and obtain accurate result. Excessive
squeezing of tissue during blood sample
collection may contribute to pain, bruising
scaring and hematoma formation.
Diabetic patients have peripheral vascular
disease making it difficult to obtain a large
drop of blood after a finger stick.
Blood enters strip and glucose device will
show message on the screen to signal enough
blood is obtained.

20 Do not scrap blood onto the test strip or apply to This prevents inaccurate glucose
wrong side of test strip. measurement.

21 Take reading, note reading

Exposure of blood to test strip for prescribed
time ensures accurate result. N/B: Some
meters such as
(One Touch Life Scan) require blood sample
to be applied to test strip already in the meter.
Once the drop of blood is applied, the meter
automatically calculates the reading.

22 Turn meter off. Dispose test strip, lancet and Meter is battery powered. Proper disposal
gloves in the proper receptacle reduces risk for needle stick injury and spread
of infection.
23 Discuss test result with patient Promotes participation and compliance with
therapy.
24 Document findings, report findings as Serves as baseline or reference information
applicable
25 Offer patient and family opportunity to practice Same as above
testing action.
26 Provide resources or teaching aids for the To facilitates learning.
patient
Note: for knowledge purposes, read further on glucose monitoring, DM, Insulin & anti-diabetics.