2Why monitor blood glucose? “Blood glucose monitoring provides insight into the effectiveness of the diabetes management plan. It enables direct feed back to the patient about their blood glucose and control.” Dunning, T “Care of people with diabetes.” 3rd Edition. Blackwell Publishing, West Sussex, UK.
4Control of glucose level The level of glucose in the blood is controlled by the hormones insulin and glucagonInsulin decreases blood glucoseGlucagon increases blood glucoseOther hormones that influence blood glucose areCortisolGrowth hormoneAdrenaline / nor adrenaline
5Types of diabetesType 1Type 11GestationalSecondary
6Factors involved in a deficiency of insulin include Insufficient productionIncreased requirements of the bodyA decrease in the effectiveness of available insulinLess commonly , increased destruction of insulin by the liver.
7When there is a deficiency of insulin , the blood glucose level rises leading to Diabetes Mellitus and eventually to pathological changes affecting small and large vessels (arthrosclerosis, retinal; damage and neuropathy.
9hyperglycaemiaThe levels of glucose in the blood is higher than 15mmol/litreManifestationsThirst tiredpolyuria hungryGlycosuria ketonuriaMay develop ketoacidosisSkin is dry and warm
10hypoglycaemiaThe level of glucose in the blood is less than 3mmol/litreThis condition progresses rapidlyCool, pale, sweaty skinSlurred speechAtaxiaHungerInability to concentrate or to think clearlyCan lead to convulsions and coma
11Reasons for monitoring blood glucose levels Determination on a regular basis of how successful medical interventions are in balancing treatment, nutritional intake and exercise.Developing a sense of controlRelating aspects of the patient’s lifestyle to the effect on their blood glucose levels.Actively assisting in the prevention of short and long term complications of diabetes.Monitoring the effectiveness of treatmentFor planning adjustments of medication dosesManaging sick days and hypoglycaemia
13Blood glucose levels Non Diabetic Normal random blood glucose –Normal fasting blood glucose – 4.0 –7.0
14When to take test Type 1 – 5-10 mmol/litre Before breakfast Before lunchBefore dinnerAnd at bedtimeTesting needs to be done regularly throughout the day because of high possibility of hypo / hyper reactions
15When to take test Type II- 4-8 mmol /litre Before breakfast Before other meals or 2 hours after mealsMay be daily, BD, or two or three times a week if stable.
16Types of monitorsVary so nurses have to become familiar with many types.Firstly need to check date on strip and insert the strip into the machine check that the serial date is the same on the container that is reading on the machine.All procedures require a large drop of blood.The strip is impregnated with a special substance (glucose oxidase) which gives a characteristic colour proportional to the amount of glucose in the blood.