blood glucose monitoring 1. why monitor blood glucose? “blood glucose monitoring provides insight...

Blood glucose monitoring

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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

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Types of diabetes

Type 1

Type 11

Gestational

Secondary

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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.

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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.

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Symptoms of hyperglycaemia

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hyperglycaemia

The levels of glucose in the blood is higher than 15mmol/litreManifestationsThirst

tired polyuria

hungryGlycosuria

ketonuriaMay develop ketoacidosisSkin is dry and warm

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hypoglycaemia

The 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

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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

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Factors influencing blood glucose

Food intakeExerciseMedicationsIllnessAlcoholStressPregnancyAge Disease -kidney, liver, pancreatic, and thyroid

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Blood glucose levels

Non Diabetic

Normal random blood glucose – 4.0 - 8.0

Normal fasting blood glucose – 4.0 –7.0

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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

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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.

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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.

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