Blood Glucose Monitoring



Definition
Blood glucose monitoring is a method of assessing the concentration of glucose in the blood. Tests are performed rapidly and easily by using a reagent strip (e.g. Glucostix) where a minute drop of capillary blood is obtained from the client’s digits (finger or toe), earlobe or heel. On the condition where the patient has all the equipments this test can be performed at home, office, hospitals, clinics and even when travelling.




Purpose
Blood glucose tests detect blood glucose levels in people with the following conditions:

1. Diabetes Mellitus (Type 1, Type 2)
2. Gestational diabetes
3. Neonatal hypoglycemia
4. Diabetic Coma

During the test, a portable blood glucose meter (e.g. Glucometer or One Touch) is used to give numerical data or measurement of a patient’s serum glucose level by inserting the blood stained plastic strip. Some meters are installed with memory application helpful in storing the sequence of test results obtained for easy evaluation.
Paraphernalia

1. Reagent strips or test strip
2. Clean Gloves
3. Alcohol pads
4. Lancets or lancing device
5. Portable glucose meter
6. Watch (with second hand)
7. Pen and Logbook for documentation

Procedure

1. Identify the patient by asking the patient to state his/her name. Also check the client’s identification band. ( confirm patient’s identity using two patient identifiers, based on the hospital protocol)
2. Explain the procedure to the patient or parents (if patient is a child) to gain cooperation.
3. Choose the puncture site. For adults and children fingertips and earlobe can be use. For infants, the tip of the great toe or heel can be the site of puncture.
4. Wash hands and don clean gloves.
5. If glucometer is used, load the strip into the device beforehand.
6. Swab alcohol pad to the chosen puncture site. Use sterile/clean gauze to dry it thoroughly. Piecing the skin with a wet skin (alcohol) allows the chemical to pass through the outer layer of the skin thus, causing the procedure more painful and uncomfortable.
7. To collect a blood sample, position the lancet (pricking needle) at the side of the site. To minimize pain and patient’s anxiety pierce the skin sharply and briefly. This technique also increases blood flow. For better results, some agencies are using a lancing device (mechanical blood-letting device) wherein the lancets are simply loaded in the spring of the equipment. (It’s like using a spring-loaded pen, once you click the button the spring releases the lancet and immediately retracts it after piercing the skin). However, be sure to load an unused lancet before using to prevent spread of blood-transmitted diseases.
8. Don’t squeeze the puncture site to prevent diluting the sample with fluids from tissues.
9. Cover the entire patch of strip with blood.
10. Place gauze over the punctured area and briefly apply pressure until the bleeding stops. Ask the parents of a child to do this.
11. If using a reagent strip, leave the blood on the strip for 1 minute (60 seconds). And watch the color change on the strip while comparing it to the standardized color chart of the product container.
12. If glucometer is used, simply follow the manufacturer’s instruction.
13. Apply an adhesive bandage once the bleeding on the puncture site has stopped.
14. Remove gloves and record the resulting glucose level from the digital display for glucometer or from the color of reagent strip to the standardized chart.

Common Errors in Blood Glucose Monitoring

1. Dropping a very small amount of blood
2. Inappropriate timing ( the test is usually performed before meals and at bedtime, or whenever hypoglycemia or hyperglycemia occurs)
3. Squeezing the puncture site too hard allowing tissue fluids to mix with the sample
4. Improper maintenance of glucometers (dust or blood accumulation on the digital display)

images from pennmedicine.org, mdconsult.com, odessaregionalmedicalcenter.com

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