1. Care of patients with endocrine system disorders Prepared by: Mrs. Alwah Alkathiri Revised by: Dr. Irene Roco Asst. Professor

2. Outline Blood Glucose monitoring Purpose/ Indication of BGM Types of Blood Glucose Tests Medications that can affect blood glucose levels Normal and diabetic blood sugar ranges Insulin Types Mixing Insulin References

3. Introduction  The endocrine system is a network of glands that produce and release hormones that help control many important body functions, especially the body's ability to change calories into energy that powers cells and organs.  Common endocrine disorders are; - Diabetes ( type 1 or type 2) - Thyroid disorder ( hyperthyroidism or hypothyroidism )

4. 1. Blood Glucose monitoring

5. Blood glucose Monitoring Blood glucose is the amount of glucose in the blood (mmol/L). Blood glucose is regulated by insulin and glucagon. Blood monitoring (BM) is used to indicate when blood glucose is not within the normal range (4-7mmol/L) ( 70-120 mg/dl). It is used to monitor and manage the treatment of both insulin-dependent diabetes mellitus (IDDM) and non-insulin dependent diabetes mellitus (NIDDM).

6. Goals for BGM Goal: To maintain blood glucose within target range. Immediate benefit: Identification, treatment, and prevention of high and low blood glucose levels. Long-term benefit: Decrease risk of long-term complications.

7. Purpose/ Indication of BGM  type 1 and type 2 diabetic patients.  unstable diabetes, (hyperglycemia, hypoglycemia, and diabetic ketoacidosis).  For diagnostic purposes of diabetes (signs and symptoms of polyuria, polydipsia, weight loss of type 1 or weight gain, family history of type 2.)  Patients taking steroids and other drugs that cause raised blood glucose.

8. Some conditions that may affect the accuracy of blood glucose monitoring (may need a venous sample) : 1.Peripheral circulatory failure and severe dehydration e.g., diabetic ketoacidosis, shock, hypotension. These conditions cause peripheral shutdown, which can cause artificially low capillary readings. 2.Some renal dialysis treatments. 3.Hyperlipidemia: cholesterol levels above 13 mmol/L may lead to artificially raised capillary blood glucose readings 4.Pre-eclampsia

9. TYPEPreparationWhat it measuresPURPOSE 1. Fasting blood sugar (FBS) - NPO for least 8 hours. measures blood glucose often the first test done to check for prediabetes and diabetes. 2. Two (2)- hour postprandial blood sugar Client eats a meal exactly 2 hours before the blood sample is taken measures blood glucose exactly 2 hours after having a meal; not used to diagnose diabetes; used to check if a diabetic client is taking the right amount of insulin with meals. 3. Random blood sugar (RBS) No preparationmeasures blood glucose regardless of when the client last ate. may be taken throughout the day. Blood glucose levels that vary widely may mean a problem. Types of Blood Glucose Tests

10. TYPEpreparationPURPOSE 4. Oral glucose tolerance test - fasting sample of blood and then taking a very sweet drink containing 75g of glucose. a series of blood glucose measureme nts used to diagnose prediabetes and diabetes, gestational diabetes. 5. Hemoglobi n A1c, or Glycohemo glo bin, Nonemeasures how much sugar (glucose) is stuck to red blood cells; used to diagnose diabetes; shows how well diabetes has been controlled in the past 2 to 3 months and whether diabetic medications needed to be changed. The result of A1c test can be used to estimate the average blood sugar level. Types of Blood Glucose Tests

11. Medications that can affect blood glucose levels Acetaminophen corticosteroids steroids diuretics oral contraceptives (birth control pills) hormone therapy aspirin atypical antipsychotics lithium epinephrine tricyclic antidepressants monoamine oxidase inhibitors (MAOIs) phenytoin sulfonylurea medications

12. Equipment Blood glucose monitor Patient record book disposable test strips Disposable lancets Quality control solution Gauze swabs disposable gloves Sharps container cleaning wipes

13. Blood glucose monitoring

14. Normal and diabetic blood sugar ranges healthy individualsDiabetics Before meals:Between 4.0 to 6.0 mmol/L (72 to 108 mg/dL) when fasting type 1 or type 2 diabetes - 4 to 7 mmol/L After meals:Up to 7.8 mmol/L (140 mg/dL) 2 hours after eating type 1 diabetes - under 9 mmol/L type 2 diabetes - under 8.5mmol/L http://www.diabetes.co.uk/

19. Role of nurse Check BG as order Document results Give medication or glucose (insulin\oral diabetic drug) Communicate blood glucose results to physician according to policy.

20. 2. Insulin administration

21. Insulin types

22. Delivery Methods Insulin Syringe Insulin Pump Insulin Pen

23. Route: Subcutaneous

24. When to Give Insulin Before meals or snacks. For blood glucose levels significantly above target range. Insulin dose is based on: Blood glucose readings Age/body weight Physical activity level. Insulin dose is based on: Blood glucose readings Age/body weight Physical activity level.

25. Mixing Insulin 1. Check the labels on the insulin bottles to make sure you have the correct insulin. Regular, lispro (Humalog) and aspart (NovoLog). Insulin should be clear. NPH insulin should be cloudy. 2. Throw away any insulin left in the bottle 30 days after you first open the bottle. 3. Gently roll the bottle of cloudy insulin between your hands until it is mixed, and there is no powder on the bottom of the bottle. 4. Do not shake the insulin bottle because this can cause air bubbles.

26. 5. Aspirate clear Insulin first before the Cloudy Insulin 6. If you get more units of cloudy insulin in the syringe than are needed, do not push any insulin back into the bottle. Remove the syringe and throw it into your needle disposal box. Get a new syringe and start over. Mixing Insulin

27. Suggested video to watch https://www.youtube.com/watch?v=gizYDn2_ 0Io

28. References http://www.healthline.com/health/glucose-test- blood#TestPreparation3 http://www.webmd.com/diabetes/blood- glucose http://www.diabetes.co.uk/ https://www.healthinfotranslations.org/pdfDocs /MixingTwoInsulins.pdf