1. Blood glucose monitoring

2. Why 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.

3. Blood glucose meter readings.

4. Control of glucose level
The level of glucose in the blood is controlled by the hormones insulin and glucagon
Insulin decreases blood glucose
Glucagon increases blood glucose
Other hormones that influence blood glucose are
Cortisol
Growth hormone
Adrenaline / nor adrenaline

5. Types of diabetes
Type 1
Type 11
Gestational
Secondary

6. Factors involved in a deficiency of insulin include
Insufficient production
Increased requirements of the body
A decrease in the effectiveness of available insulin
Less commonly , increased destruction of insulin by the liver.

7. When 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.

8. Symptoms of hyperglycaemia

9. hyperglycaemia
The levels of glucose in the blood is higher than 15mmol/litre
Manifestations
Thirst tired
polyuria hungry
Glycosuria ketonuria
May develop ketoacidosis
Skin is dry and warm

10. hypoglycaemia
The level of glucose in the blood is less than 3mmol/litre
This condition progresses rapidly
Cool, pale, sweaty skin
Slurred speech
Ataxia
Hunger
Inability to concentrate or to think clearly
Can lead to convulsions and coma

11. Reasons 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 control
Relating 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 treatment
For planning adjustments of medication doses
Managing sick days and hypoglycaemia

12. Factors influencing blood glucose
Food intake
Exercise
Medications
Illness
Alcohol
Stress
Pregnancy
Age
Disease -kidney, liver, pancreatic, and thyroid

13. Blood glucose levels Non Diabetic
Normal random blood glucose –
Normal fasting blood glucose – 4.0 –7.0

14. When to take test Type 1 – 5-10 mmol/litre Before breakfast
Before lunch
Before dinner
And at bedtime
Testing needs to be done regularly throughout the day because of high possibility of hypo / hyper reactions

15. When to take test Type II- 4-8 mmol /litre Before breakfast
Before other meals or 2 hours after meals
May be daily, BD, or two or three times a week if stable.

16. Types of monitors
Vary 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.