Transcript Care of patients with endocrine system disorders

Blood Glucose Measurement And
Insulin Administration
Outline
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Blood Glucose monitoring
Purpose/ Indication of BGM
Types of Blood Glucose Tests
Medications that can affect blood glucose levels
Normal and diabetic blood sugar ranges
Insulin Types
Mixing Insulin
References
Introduction
 Blood Glucose Monitoring is a cornerstone of
diabetes management and Self Monitoring of
blood Glucose (SBMG) levels by patient has
dramatically altered diabetes care
 Frequent SBMG enables diabetic patients to
adjust the treatment regimen to obtain optimal
blood glucose control
1. Blood Glucose Measurement
• Blood glucose is the amount of glucose
in the blood (mmol/L).
• Blood glucose is regulated by insulin
and glucagon.
• Blood monitoring (BM) is used to
indicate when blood glucose is not
within the normal range (4-7mmol/L)
( 70-120 mg/dl) .
• It is used to monitor and manage the
treatment of both insulin-dependent
diabetes mellitus (IDDM) and
non-insulin dependent diabetes
mellitus (NIDDM).
Goals for BGM
• To maintain blood glucose within target range.
Immediate benefit:
• Identification, treatment, and prevention of high and
low blood glucose levels.
Long-term benefit:
• Decrease risk of long-term complications.
Purpose/ Indication of BGM
 type 1 and type 2 diabetic patients.
 unstable diabetes, (hyperglycemia, hypoglycemia, and
diabetic ketoacidosis).
 For diagnostic purposes of diabetes (signs and symptoms
of polyuria, polydipsia, weight loss of type 1 or weight
gain, family history of type 2 .)
 Patients taking steroids and other drugs that cause raised
blood glucose.
Some conditions that may affect the accuracy
of blood glucose monitoring
(may need a venous sample) :
1. Peripheral circulatory failure and severe dehydration e.g.,
diabetic ketoacidosis, shock, hypotension. These conditions
cause peripheral shutdown, which can cause artificially low
capillary readings.
2. Some renal dialysis treatments.
3. Hyperlipidemia: cholesterol levels above 13 mmol/L may lead
to artificially raised capillary blood glucose readings
4. Pre-eclampsia
Types of Blood Glucose Tests
TYPE
Preparation
What it
measures
PURPOSE
1. Fasting
blood sugar
(FBS) -
NPO for least 8
hours.
measures blood
glucose
often the first test done to
check for prediabetes and
diabetes.
2. Two (2)hour
postprandial
blood sugar
Client eats a
meal exactly 2
hours before
the blood
sample is taken
measures blood
glucose exactly 2
hours after having
a meal;
not used to
diagnose diabetes;
used to check if a diabetic
client is taking the right
amount of insulin with meals.
3. Random
blood sugar
(RBS)
No preparation
measures blood
glucose
regardless of
when the client
last ate.
may be taken throughout the
day. Blood glucose levels that
vary widely may mean a
problem.
Types of Blood Glucose Tests
TYPE
preparation
4. Oral
glucose
tolerance
test -
fasting sample of
blood and then
taking a very
sweet drink
containing 75g of
glucose.
5.
None
Hemoglobi
n A1c, or
Glycohemo
glo
bin,
PURPOSE
a series of
blood
glucose
measureme
nts
used to
diagnose prediabetes and
diabetes, gestational
diabetes.
measures
how much
sugar
(glucose) is
stuck to
red blood
cells;
used to diagnose diabetes;
shows how well diabetes has
been controlled in the past 2
to 3 months and whether
diabetic medications needed
to be changed.
The result of A1c test can be
used to estimate the
average blood sugar level.
Medications that can affect blood
glucose levels
Acetaminophen
corticosteroids
steroids
diuretics
oral contraceptives
(birth control pills)
hormone therapy
aspirin
Atypical
antipsychotics
lithium
epinephrine
tricyclic
antidepressants
monoamine oxidase
inhibitors (MAOIs)
phenytoin
sulfonylurea
medications
Equipment
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Blood glucose monitor
Patient record book
disposable test strips
Disposable lancets
Quality control solution
Gauze swabs
disposable gloves
Sharps container
cleaning wipes
Blood glucose monitoring
Normal and diabetic blood sugar
ranges
healthy individuals
Diabetics
Before
meals:
Between 4.0 to 6.0
mmol/L (72 to 108
mg/dL) when fasting
type 1 or type 2 diabetes - 4 to 7
mmol/L
After meals:
Up to 7.8 mmol/L
(140 mg/dL) 2 hours
after eating
type 1 diabetes - under 9 mmol/L
type 2 diabetes - under 8.5mmol/L
http://www.diabetes.co.uk/
Role of nurse
• Check BG as ordered
• Document results
• Give medication or glucose (insulin\oral diabetic
drug)
• Communicate blood glucose results to physician
according to policy.
2. Insulin administration
Insulin types
Delivery Methods
1. Insulin Syringe
3. Insulin Pen
2. Insulin Pump
4. Infusion
Human regular insulin may be injected •
directly into the vein in a hospital setting,
with doctor’s order, under close medical
supervision only
Insulin is added to intravenous fluids, and the •
insulin dose and blood sugar are strictly
monitored.
Route: Subcutaneous
General Considerations concerning
Insulin Administration
1. Dosage depends on glycemic response of the individual to food
intake and exercise regimens. (Type 1 diabetic patients and some type
2 diabetic patients may require both rapid- or short- and longer-acting
insulins, three or more injections per day to meet glycemic goals.)
2. The timing of the injection depends on blood glucose levels, food
consumption, exercise, and types of insulin used. Variables in insulin
action (e.g., onset, peak, and duration) must be considered.
3. Rapid-acting insulin analogs should be injected within 15 min
before a meal or immediately after a meal. The most commonly
recommended interval between injection of short-acting (regular)
insulin and a meal is 30 min.
Mixing Insulin
1. Check the labels on the insulin bottles to make
sure you have the correct insulin. Regular, lispro
(Humalog) and aspart (NovoLog) Insulin should be
clear. NPH insulin should be cloudy.
2. Throw away any insulin left in the bottle 30 days
after you first open the bottle.
3. Gently roll the bottle of cloudy insulin between
your hands until it is mixed, and there is no powder
on the bottom of the bottle.
Mixing Insulin
4. Do not shake the insulin bottle because this can cause
air bubbles. Tiny air bubbles are not dangerous, but they
will decrease the amount of insulin in the syringe.
5. Aspirate clear Insulin first before the Cloudy Insulin
6. If you get more units of cloudy insulin in the syringe
than are needed, do not push any insulin back into the
bottle. Remove the syringe and throw it into your needle
disposal box. Get a new syringe and start over.
Patient Education
A - Storage
1. Vials of insulin not in use should be refrigerated. Extreme
temperatures (<36 or >86°F, <2 or >30°C) and excess agitation should
be avoided to prevent loss of potency, clumping, frosting, or
precipitation.
2. Specific storage guidelines provided by the manufacturer should be
followed. Insulin in use may be kept at room temperature to limit local
irritation at the injection site, which may occur when cold insulin is
used.
3. The patient should always have available a spare bottle of each type
of insulin used. Although an expiration date is stamped on each vial of
insulin, a loss in potency may occur after the bottle has been in use for
>1 month, especially if it was stored at room temperature.
Patient Education
4. Inspect the bottle before each use for changes (i.e.,
clumping, frosting, precipitation, or change in clarity or
color) that may signify a loss in potency.
5. Relate any unexplained increase in blood glucose to
possible reductions in insulin potency.
6. If uncertain about the potency of a vial of insulin, the
patient should replace the vial with another of the same
type.
Rapid- and short-acting insulins as well as insulin glargine to be
clear ; all other insulin types are uniformly cloudy
.
PATIENT MANAGEMENT
B - Self-monitoring
1. Whenever possible, insulin-using patients should practice self-monitoring of blood
glucose (SMBG
2. Illness, traveling, and any change in routine (e.g., increased exercise and a different
diet during vacation) may require more frequent SMBG under the guidance of a
physician.
3. During illness, it is important that insulin be continued even if the patient is unable
to eat or is vomiting.
4. When accompanied by hyperglycemia, a positive urine or blood test for ketones
during illness indicates a need for extra, not less, insulin.
5. Eating within a few minutes after (or before) injecting short-acting insulin is
discouraged because it substantially reduces the ability of that insulin to prevent a
rapid rise in blood glucose and may increase the risk of delayed hypoglycemia
PATIENT MANAGEMENT
C - Hypoglycemia
1. All insulin-requiring individuals should be instructed to carry at least 15 g
carbohydrate to be eaten or taken in liquid form in the event of a
hypoglycemic reaction.
2. Family members, roommates, school personnel, and coworkers should be
instructed in the use of glucagon for situations when the individual cannot be
given carbohydrate orally.
3. All insulin users should carry medical identification (e.g., a bracelet or
wallet card) that alerts others to the fact that the wearer uses insulin.
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Suggested video to watch
https://www.youtube.com/watch?v=gizYDn2_ •
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References
http://www.healthline.com/health/glucose-testblood#TestPreparation3
http://www.webmd.com/diabetes/bloodglucose
http://www.diabetes.co.uk/
https://www.healthinfotranslations.org/pdfDocs
/MixingTwoInsulins.pdf