Unit 1: Blood Glucose Monitoring

Topic Outline
1. Definition
2. Purposes
3. Principles and Concepts

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4. Equipment’s needed
5. Proper procedure of Blood Glucose Monitoring

Learning Outcomes
After studying this unit, you will be able to:
 Define the different terms associated with Blood Glucose Monitoring
 What are the indications of Blood Glucose Monitoring
 Determine the importance of Blood Glucose Monitoring

Introduction

Testing your blood sugar level is one of the best ways to understand your diabetes and how different
foods, medications, and activities affect your diabetes. Keeping track of your blood glucose can help you and
your doctor make a plan to manage this condition. People use portable blood glucose meters, called
glucometers, to check their blood sugar levels. These work by analysing a small amount of blood, usually from a
fingertip. A lancet lightly pricks your skin to obtain the blood. Meters tell you your current blood sugar. But, since
blood sugar levels change, you need to test levels often and record them .

Discussion

Blood glucose monitoring

Blood glucose monitoring is the use of a glucose meter for testing the concentration of glucose
in the blood (glycemia). Particularly important in diabetes management, a blood glucose test is
typically performed by piercing the skin (typically, on the finger) to draw blood, then applying
the blood to a chemically active disposable 'test-strip'. Different manufacturers use different
technology, but most systems measure an electrical characteristic, and use this to determine
the glucose level in the blood. The test is usually referred to as capillary blood glucose.

Healthcare professionals advise patients with diabetes mellitus on the appropriate monitoring
regimen for their condition. Most people with type 2 diabetes test at least once per day. The Mayo
Clinic generally recommends that diabetics who use insulin (all type 1 diabetics and many type
2 diabetics) test their blood sugar more often (4–8 times per day for type 1 diabetics, 2 or more
times per day for type 2 diabetics),both to assess the effectiveness of their prior insulin dose and
to help determine their next insulin dose.

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 Purpose
Blood glucose monitoring reveals individual patterns of blood glucose changes, and helps in the
planning of meals, activities, and at what time of day to take medications.

Also, testing allows for quick response to high blood sugar (hyperglycemia) or low blood sugar
(hypoglycemia). This might include diet adjustments, exercise, and insulin (as instructed by the
health care provider).

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Blood glucose meters

Four generations of blood glucose meter, c. 1991–2005. Sample sizes vary from 30 to 0.3 μl. Test
times vary from 5 seconds to 2 minutes (modern meters typically require less than 15 seconds).
A blood glucose meter is an electronic device for measuring the blood glucose level. A relatively
small drop of blood is placed on a disposable test strip which interfaces with a digital meter.
Within several seconds, the level of blood glucose will be shown on the digital display. Needing
only a small drop of blood for the meter means that the time and effort required for testing is
reduced and the compliance of diabetic people to their testing regimens is improved
significantly. Although the cost of using blood glucose meters seems high, it is believed to be a
cost benefit relative to the avoided medical costs of the complications of diabetes.alternate site
testing, the use of blood drops from places other than the finger, usually the palm or forearm.
This alternate site testing uses the same test strips and meter, is practically pain free, and gives
the finger tips a needed break if they become sore. The disadvantage of this technique is that
there is usually less blood flow to alternate sites, which prevents the reading from being accurate
when the blood sugar level is changing.

Continuous glucose monitoring

A continuous glucose monitor determines glucose levels on a continuous basis (every few
minutes).A typical system consists of a disposable glucose sensor placed just under the skin,
which is worn for a few days until replacement a link from the sensor to a non-implanted
transmitter which communicates to a radio receiver an electronic receiver worn like a pager (or
insulin pump) that displays glucose levels with nearly continuous updates, as well as monitors
rising and falling trends.

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All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
 Continuous glucose monitors measure the concentration of glucose in a sample of interstitial
fluid. Shortcomings of CGM systems due to this fact are:continuous systems must be calibrated
with a traditional blood glucose measurement (using current technology) and therefore require
both the CGM system and occasional "fingerstick" glucose levels in interstitial fluid lag behind
blood glucose values. Patients therefore require traditional fingerstick measurements for
calibration (typically twice per day) and are often advised to use fingerstick measurements to
confirm hypo- or hyperglycemia before taking corrective action.

The lag time discussed above has been reported to be about 5 minutes.Anecdotally, some users

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of the various systems report lag times of up to 10–15 minutes. This lag time is insignificant when
blood sugar levels are relatively consistent. However, blood sugar levels, when changing rapidly,
may read in the normal range on a CGM system while in reality the patient is already
experiencing symptoms of an out-of-range blood glucose value and may require treatment.
Patients using CGM are therefore advised to consider both the absolute value of the blood
glucose level given by the system as well as any trend in the blood glucose levels. For example,
a patient using CGM with a blood glucose of 100 mg/dl on their CGM system might take no action
if their blood glucose has been consistent for several readings, while a patient with the same
blood glucose level but whose blood glucose has been dropping steeply in a short period of time
might be advised to perform a fingerstick test to check for hypoglycemia.

Continuous monitoring allows examination of how the blood glucose level reacts to insulin,
exercise, food, and other factors. The additional data can be useful for setting correct insulin
dosing ratios for food intake and correction of hyperglycemia. Monitoring during periods when
blood glucose levels are not typically checked (e.g. overnight) can help to identify problems in
insulin dosing (such as basal levels for insulin pump users or long-acting insulin levels for patients
taking injections). Monitors may also be equipped with alarms to alert patients of hyperglycemia
or hypoglycemia so that a patient can take corrective action(s) (after fingerstick testing, if
necessary) even in cases where they do not feel symptoms of either condition. While the
technology has its limitations, studies have demonstrated that patients with continuous sensors
experience less hyperglycemia and also reduce their glycosylated hemoglobin levels.

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All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
 Key Terms
 Type 2 Diabetes Mellitus
 Type 1 Diabetes Mellitus
 Hypoglycemia
 Hyperglycema

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 Insulin
 Lancet
 Blood Sugar Level
 Diabetic Ketoacidosis
 Diabetic Coma

Read
Medical-Surgical Nursing (Brunner and Suddarth 14 th Edition)
Terms and definitions: http://self.gutenberg.org/articles/eng/tpal_(medicine)

Demonstration Link (Blood Glucose Monitoring)

View this demonstration by clicking the following link to learn more about Blood Glucose Monitoring.
https://www.youtube.com/watch?v=rMMpeLLgdgY

Readings and References

Medical-Surgical Nursing (Brunner and Suddarth 14th Edition)
https://www.youtube.com/watch?v=rMMpeLLgdgY

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All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.