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NT Skills Update - BLOOD GLUCOSE MONITORING

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VOL: 98, ISSUE: 46, PAGE NO: 31

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BLOOD GLUCOSE

The body regulates blood glucose by producing insulin. Insulin lowers blood glucose levels and influences protein and fat metabolism.

The body regulates blood glucose between 4 and 7mmol/l (72-126mg/dl). To obtain readings, samples are taken from capillary, venous or arterial routes; depending on accessibility, the patient's condition and frequency of testing.

WHY MONITOR BLOOD GLUCOSE LEVELS?

- To assist a diagnosis of diabetes mellitus;

- To diagnose hypoglycaemia (low blood glucose);

- To monitor blood glucose readings that are incompatible with the clinical status of the patient;

- As an aid to the management of unstable diabetic conditions such as diabetic ketoacidosis.

TESTING CHECKLIST

- Ensure the monitor and test strips are calibrated and strips are not out of date. A twice-daily quality-control test should have been performed and documented;

- Explain the test to the patient and encourage the patient to have clean, warm hands;

- Perform the test wearing surgical gloves;

- Prick the side of the finger with the lancet (avoid over use of the index finger and the thumb as the site of choice) and rotate it towards the stick;

- Ensure the blood drops onto the stick in one application;

- Record the result immediately and dispose of sharps appropriately;

- Observe test site for excessive bleeding;

- Policies and equipment for testing vary between hospitals and only staff with a certificate in the use of the monitoring equipment should test blood glucose levels.

ABNORMALITIES

Hypoglycaemia

- Symptoms: sweating; tachycardia; hypertension; and seizures.

- Causes: alcohol consumption; renal impairment/failure; insufficient/erratic food intake; surgery; insulin-secreting tumours; salicylate poisoning; hepatic failure due to tumour; cirrhosis or hepatic necrosis.

- Treatment: administration of glucose. The route will depend on the level of consciousness of the patient and the treatment he or she has received.

Hyperglycaemia

Symptoms: polyuria; thirst; dehydration; drop in blood pressure; electrolyte imbalance; abdominal pain; nausea/vomiting.

Causes: When insulin is depleted or absent, blood glucose remains high after a meal. Insulin allows glucose to enter a cell; if it is absent, the body reacts to the cells being starved of glucose by producing reactions seen in hypoglycaemia.

Treatment: fluid replacement, restoration of acid-base balance, insulin via sliding scale and 1-2 hourly blood glucose monitoring.

WEBSITES

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