Manual for Blood Glucose Monitoring using a Glucometer
Abstract: The purpose of this manual is to inform patients for blood glucose monitoring using a blood glucose meter. Blood glucose monitoring is a measurement of glucose (sugar) in the blood. The test can be done at any time on a portable meter. It can be a self-test for a patient with diabetes.
The blood glucose meter is especially well suited for diabetes patients who frequently monitor their glucose Levels and is intended to help protect the patients by alert users to high and low glucose levels. The information and retrospective glucose trend data provided by the meter are designed to help patients more tightly control glucose levels.
There are now dozens of models of glucose meters. Typical features common to most. The average size is now approximately the size of the palm of the hand, though some are smaller or a bit larger. They are battery-powered. A consumable element containing chemicals, which react with glucose in the drop of blood, is used for each measurement. For most models, this element is a plastic test strip with a small spot impregnated with glucose oxidase and other components. Each strip can only be used once and is then discarded.
Introduction: Glucometer is designed for people with diabetes who are seeking simple, more affordable blood glucose testing. Focusing on just the basics of testing, it offers fast, accurate blood glucose results provided in a lightweight, easy-to-use meter. The system is reasonably priced and is intended to help people with diabetes overcome barriers to testing so that they can manage their blood sugar, and reduce their risk for long-term diabetes complications.
Features: Simple test process for fast, accurate results: Touching blood sample to test strip triggers 5-second countdown, which leads to a result.
Internal memory: Stores up to 50 test results with date and time. Easily accessed through two simple scrolling buttons
Requires only a speck of blood just 1 microliter. The strip uses capillary action to automatically draw blood into the tip of the test strip on contact.
Lightweight, portable and easy to carry: Easily fits into a suit/shirt pocket or a handbag. The entire kit is conveniently small and discreet; testing can be performed with the meter in the carrying case.
Offers alternate-site testing—Tests can be performed on the forearm and palm, in addition to conventional fingertip testing.
Why monitor Blood Glucose? Monitoring your blood sugar also called glucose level can help you take better care of your diabetes. Checking your blood sugar will help you learn how food, activity levels, stress, medicine and insulin change your blood sugar level. This information will help you stay healthy and prevent or delay diabetic complications such as blindness and kidney failure. This manual will give you some tips on monitoring your blood sugar level. Knowing the blood glucose level fills in some of the blanks in patient assessment and allows determining an appropriate course of treatment for the patient. It provides information that is valuable to advanced life support providers and the hospital personnel.
Types of Diabetes
Type I (Juvenile Onset)
Generally insulin dependent
Can develop in childhood or later in life
Patients are likely to have complications from the effects of the disease
Type II (Adult Onset)
May be controlled by diet or oral medications
Less likely to have insulin dependency
Less likely to experience hypoglycemia
Still at risk for complications for the effects of the disease
Normal Blood Glucose Levels
Normal ranges for blood glucose levels:
Infant (40 – 90 mg/dl)
Child < 2 years (60 – 100 mg/dl)
Child > 2 years to Adult (70 – 105 mg/dl)
Elderly patients (50 y/o +) often have a slightly elevated blood glucose level, but should not normally exceed 126 mg/dl.
These readings could be altered by time of day and last oral intake. Values reflected are fasting values.
Increased Blood Glucose Levels: are indicative of several potential processes such as Diabetes mellitus, acute stress response, Cushing’s disease, Diuretic therapy and Corticosteroid therapy
Decreased Blood Glucose Levels: are indicative of several potential processes such as Insulinoma, Hypothyroidism, Addison’s disease, Extensive liver disease, Hypopituitarism and Pancreatic disease or cancer
Hypoglycemia (BS < Normal)
Normal or rapid respirations, Pale, moist skin
Diaphoresis, Dizziness, headache
Rapid pulse, Normal or low BP
Altered mental status, Anxious or combative
Seizure or fainting and Coma
Hyperglycemia (BS > 200 mg/dl)
Dehydration with dry, warm skin and sunken eyes
A sweet or fruity (acetone) odor to breath
Rapid and weak pulse, Normal or slightly low BP
Varying degrees of unresponsiveness that onsets more slowly than in hypoglycemia
Equipment needed: Exam gloves, Alcohol prep pads, Glucometer, Test strips, Cotton balls or gauze pads, Band-aid, Lancets, Sharps container and proper waste disposal container
How-to- use- Glucometer-Instructions
Wash your hands and dry them well before doing the test.
Use an alcohol pad to clean the area that you are going to prick. With many glucose meters, you get a drop of blood from your fingertip. However, with some meters, you can also use your forearm, thigh or the fleshy part of your hand. Ask your doctor what area you should use with your meter.
Prick yourself with a sterile lancet to get a drop of blood. (If you prick your fingertip, it may be easier and less painful to prick it on one side, not on the pad.)
Place the drop of blood on the test strip.
Follow the instructions for inserting the test strip into the glucose meter.
The meter will give you a number for your blood sugar level.
Preparation of the Site
Cleanse with 70% isopropyl alcohol using a scrubbing motion
Do NOT use iodine
Allow alcohol to dry
Preparing the Glucometer
Some glucometers require loading the test strip PRIOR to applying the blood sample, while others load the test strip after applying the blood sample
Ensure the glucometer is “ON” and the test strip matches the glucometer code
Acquiring Blood Specimens
Using the lancet, stick the site
Form a small drop of blood and apply to the test strip as directed by the glucometer instructions
Allow the glucometer to process the information and return a reading
Hold pressure on lancet site and apply band-aid
Record the findings
Care of the Blood Glucometer:
Handle with care!
Do NOT expose to excessive heat, humidity, cold, dust, or dirt
Clean as directed by manufacturer
Store the glucometer in the case provided by the manufacturer
Benefits of glucometer are convenience and safety to the patient on many levels
Since patients can check and monitor their own blood glucose levels at their leisure, they do not have to travel to a healthcare facility to have their venous or arterial blood drawn.
Therapy and treatment is rendered quickly at their homes.
Since the blood sample these portable devices require is smaller than that needed for automated laboratory and chemistry analyzers, BGM can reduce patient blood loss due to laboratory testing.
Cost is greatly reduced for the care and treatment of diabetic patients for all parties involved: the patient, the healthcare facility, insurance providers and the physician.
Maintenance: Set up requires identification of
Proper batch numbers for test strips
Routine control testing
Calibration when necessary
Trouble shooting:
Manual covers MOST issues for specific glucometers
Display goes blank
Function number is different from test strip number
Result is “Out of Range”
Meter does NOT count down
Display segments are incomplete
Meter reads “Lo”
Meter reads “Hi”
Control tests are inconsistent or within a specified range
FAQ
Your A1C level should ideally be under 7 and you would want to discuss higher levels with your doctor.
What if I can’t get a drop of blood?
If you get blood from your fingertip, try washing your hands in hot water to get the blood flowing. Then dangle your hand below your heart for a minute. Prick your finger quickly and then put your hand back down below your heart. You might also try slowly squeezing the finger from the base to the tip.
What do I do with the results?
Write down the results in a record book. You can use a small notebook or ask your doctor for a blood testing record book. You may also want to keep track of what you have eaten, when you took medicine or insulin, and how active you have been during the day. This will help you see how these things affect your blood sugar.
How often should I check my blood sugar level?
It is important to monitor your blood sugar on a regular basis. Many people start by checking their blood sugar 2 times a day: before breakfast and before supper. After a few weeks, some people are able to measure their blood sugar level only 2 or 3 times a week.
Is there another way to check my blood sugar at home?
The U.S. Food and Drug Administration (FDA) has approved meters that work without pricking your finger. But these meters cannot replace regular glucose meters. They are used to get additional readings between regular testing.
If the results are too low you may be in danger of passing out, and you should eat something sweet to raise your blood glucose level.
If the results are, too high you should look at your diet, and discuss this with your doctor. Your doctor may want to change your medication if the results are always too high.
If you are ill, you should normally test more often, as blood glucose levels can change during illness.
Follow the instructions fully when using your blood glucose meter, as it is much more likely to get a wrong reading by using it wrongly, than by the meter being wrong.
If you have a problem or question about your blood glucose meter, then phone the manufacturers help line. These are normally excellent, and you can often get things free, such as new batteries and test solutions.
Glossary:
BGM Blood Glucose Monitor
BS Blood Sugar
FAQ Frequently asked Questions
HbA1c. This test will show the average blood level of glucose over the last few of months. This is glycosolated haemoglobin, or in other words, the glucose in your blood that permanently sticks to the circulating red cells in your blood. This HbA1c level changes very slowly, unlike the actual glucose level in blood, which can change quickly.
Hyperglycemia Unduly high blood sugar
Hypoglycemia Abnormally low blood sugar
Lancets A special needle used to prick the finger to draw a small amount of blood for testing. They are best used in the special ‘pens’ that come with the blood glucose meters.
Test strips are used only once, and then thrown away. It is important to keep them in their original container, and to put the lid back on quickly, as they are often sensitive to moisture in the air. Test strips vary from batch to batch and need to have a batch number put into the meter when one open a new pot. Do not use test strips after their expiry date. Check their expiry dates, as some only have a two or three month life once opened.
Reference:
Diabetes Information – Glucose Meters and Diabetes Management. January 9, 2006.
ECRI Health Devices Alerts Special Report Accession Number: S0067 April 1, 2005.
ECRI Healthcare Product Comparison System Blood Glucose Monitors April 2003.
http://www.glucosemeters.diabetic-source.com/
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Jon E. Friesen (2003) Monitoring Blood Glucose Levels Sedgwick County EMS Sedgwick County, Kansas