Blood glucose monitoring

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. 2009. “Care of people with diabetes.” 3rd Edition. Blackwell Publishing, West Sussex, UK.

Blood glucose meter readings. http://www.youtube.com/watch?v=UQZRjmjcMZs

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

Types of diabetes Type 1 Type 11 Gestational Secondary

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.

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.

Symptoms of hyperglycaemia

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

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

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

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

Blood glucose levels Non Diabetic Normal random blood glucose – 4.0 - 8.0 Normal fasting blood glucose – 4.0 –7.0

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

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.

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.