Monitoring Glucose Levels and Ketones

Self-Monitoring of Blood Glucose (SMBG)

This allows for detection and prevention of hypoglycemia and hyperglycemia and plays a crucial role in normalizing blood glucose levels, which in turn may reduce the risk of long term diabetic complications.

METHODS
1. a. Obtaining a drop of blood from the fingertip b. Applying the blood to a special reagent strip c. allowing the blood to stay on the strip for the amount of time specified by the manufacturer (usually 5 to 30 sec.) 2. a. meter gives a digital readout of the blood glucose valve. b. Some meters are biosensors that can use blood obtained from alternative test sites, such as the forearm. Plasma glucose values are 10% to 15% higher than whole blood glucose values.

Factors affecting SMBG performance include:

1) 2) 3) 4) visual acuity fine motor coordination cognitive ability comfort with technology and willingness to use it 5) cost

Potential hazards of all methods of SMBG

1. Patient may obtain and report erroneous blood glucose values as a result of using incorrect techniques.

2. What are some common sources of error in all the methods?

2.1 Improper application of blood (e.g. drop too small) 2.2 Damage to the reagent strips caused by heat or humidity. 2.3 use of outdated strips 2.4 improper meter cleaning and maintenance

Nurses Role:
Teaching about SMBG techniques Every 6-12 months _______________, patient should conduct a comparison of their meter result with a simultaneous laboratory measured blood glucose level in their physicians office and have their technique observed. assessed the accuracy of the meter and strips with control solutions specific to that meter whenever a new vial of strips is used and whenever the validity of the reading is in doubt.

Candidates for SMBG

SMBG
Is a useful tool for managing selfcare for everyone with diabetes.

Recommended for patients with the following conditions:

unstable diabetes (severe swings from very high to very low blood glucose level within a 24-hour day) A tendency to develop severe ketosis or hypoglycemia Hypoglycemia without warning symptoms

Patients not taking Insulin; insulin is helpful for:

1. Monitoring the effectiveness of exercise 2. Diet

3. Oral anti-diabetic agents

4. Motivates patients to continue with the treatment

Patients having type 2 DM; SMBG is recommended during:

periods of suspected hyperglycemia or hypoglycemia.
when the medication or dosage of medication is modified.

Frequency of SMBG
Patients that requires insulin; SMBG is recommended 2-4x daily (usually before meals and at bedtime. Patients that takes insulin before each meal; SMBG is required at least 3x daily before meals to determine each dose.

Patients not receiving insulin; Instruct to assess BGL at least 2-3x per week including a 2-hour postprandial test.
For all Patients; Testing is recommended whenever Hypoglycemia or hyperglycemia is suspected, with changes in medications, activity, or diet, & with stress or illness.

Responding to SMBG Results

patients are asked to keep a record or logbook of BGL so that they can detect patterns. testing is performed before meals to evaluate basal insulin and determine bolus insulin doses to determine bolus doses of regular or rapid-acting insulin, aspart glusiline, testing is done 2 hours after meals. patients who take insulin at bedtime or who use an insulin infusion pump should also test at 3 Am once a week to document that the BGL is not decreasing during the night.

If the patient is unwilling or cannot afford to test frequently, then once or twice a day may be sufficient if the time of testing is varied. a tendency to discontinue SMBG is more likely to occur if the patient does not receive instruction about using the results to alter the treatment regimen, if positive reinforcement is not given, and if cost of testing increase. Baseline patterns should be established by SMBG for 1 to 2 weeks.

Testing for Ketones

Ketones are byproducts of fat breakdown & they accumulate in the blood and urine. when present in urine, it signals that there is deficiency of insulin & control of type 1 diabetes Is deteriorating.

No effective Insulin available

Body starts to breakdown stored fat for energy

Risk of DKA is high

Urine Ketone Testing

Is the most common method used for self-testing of ketone bodies by patients. Should be perfumed whenever patients with type 1 diabetes have glycosuria or persistently elevated blood glucose levels (<240 mg/dL or 13.2 mmol/L for 2 testing periods in a row) & during illness, in pregnancy with preexisting diabetes, & in gestational diabetes.

Urine Dipstick
Commonly used to detect ketonuria wherein the reagent pad on the strip turns purple when ketones are present.
one of the ketone bodies is acetone -this term is used interchangeably with the term ketones. large amounts of ketones may depress the color response of the glucose test area.

Using a continuous Glucose Monitoring System

Continuous glucose monitoring system (CGMS) - can be used to continuously monitor blood glucose levels.

How many hours, the data from the device are downloaded and blood glucose reading are analyzed? _____ hours 72

Glycosylated Hemoglobin Test

A blood test that reflects average blood glucose levels over a period of approximately 2 to 3 months.

Approximately how many days do glucose molecules 120 attach to hemoglobin in red blood cells? _____ days

That would be all! Hoped you learned something!

Made by: Group 7

o Dagoplo, Leonilyn o Rocas, Jenn Angela o Amora, Brenjelou Faith o Lopez, Myrine o Jala, Mary Ann