Clients living with diabetes may need to have their blood glucose level (BGL) monitored and kept within a target range. Maintaining an appropriate BGL is critical in reducing the risk of diabetes-related complications (Diabetes Australia 2019).

Blood Glucose Monitoring Equipment

To monitor a client’s BGL you will need the following equipment:

• Blood glucose meter
• Lancet device with lancets
• Blood glucose checking strips.

(Diabetes Australia 2019)

When Should Blood Glucose Levels be Monitored?

This should be decided by an appropriately qualified medical practitioner. Depending on the client, you may need to check their BGL at certain times such as:

• Before breakfast
• Before lunch or dinner
• Two hours after a meal
• Before bed
• Before exercise
• When they are feeling unwell.

(Diabetes Australia 2019)

How to Monitor Blood Glucose Levels

1. Instruct the client to wash their hands in warm, soapy water and dry them thoroughly (to remove contaminants)
2. Perform hand hygiene and don gloves
3. Insert the checking strip into the blood glucose meter. The blood sample side of the strip should remain on the outside of the machine during the testing process
4. Prick the side of the client’s fingertip with the lancet
5. Add a small drop of blood onto a blood glucose checking strip
6. The blood glucose meter will then display the client’s blood glucose level in millimoles per litre of blood (mmol/L)
7. Immediately dispose of the lancet in a sharps container
8. Remove gloves and perform hand hygiene.

(Diabetes Australia 2019; Diabetes NSW & ACT 2020; Minnesota DoH 2018; Healthdirect 2020)

Blood Glucose Targets

Once you have tested the client’s BGL, you should check to make sure that the reading falls within the target range.

Note: The following targets are a guide only. Each client should have a suitable target recommended by an appropriately qualified healthcare professional. Always refer to your organisation’s policies and procedures first.

(Adapted from NDSS 2020)

Document these readings and report to the appropriate clinical care staff if they are outside the target ranges.

Equipment Troubleshooting

The blood glucose meter may stop working properly for several reasons, including:

• Being too old, hot, damp or dirty
• Dead batteries or battery failure
• Damaged or out-of-date testing strips
• Incorrect calibration code
• Using the wrong type of testing strip
• Using the same testing strip more than once
• Having an inadequate amount of blood on the testing strip
• Putting the testing strip in the wrong way
• Contaminated hands, which may interfere with the reading
• Changes in temperature or humidity, which may interfere with the reading.

(Healthdirect 2020; Diabetes NSW & ACT 2020)

The following strategies may help to prevent equipment issues:

• Always read and follow the manufacturer’s instructions
• Ensure that both you and the client wash your hands before performing the test (avoid using wet wipes, as these contain chemicals that might interfere with the reading)
• Check that you’re using the correct type of testing strip
• Ensure that you put the testing strip in the right way
• Ask for help from colleagues if needed or contact the manufacturer’s helpline.

(Healthdirect 2020)

When to Escalate Care

The following symptoms may indicate a deterioration in the client’s health and require escalation of care to your responding clinical support team.

Signs that the client may be experiencing hypoglycaemia (BGL is too low) are a BGL of 4.0 mmol/L or lower as well as any of the following symptoms:

• Weakness, trembling or shaking
• Dizziness or lightheadedness
• Sweating
• Headache
• Hunger
• Irritability or aggression
• Difficulty concentrating
• Numbness or tingling near the fingers, face or lips
• Anxiety or fear
• Slurred speech
• Confusion
• Reduced coordination
• Reduced consciousness or loss of consciousness
• Seizures
• Sleeping before meals (in older adults)
• Cognitive and behavioural changes (in older adults)
• Falls (in older adults).

(VIC DoH 2018)

Signs that the client may be experiencing hyperglycaemia (BGL is too high) include:

• Excessive thirst
• Passing frequent, large volumes of urination
• Fatigue
• Blurred vision
• Infection
• Unplanned weight loss.

(Diabetes Australia 2015)

Infection Control

BGL monitoring poses a risk of transmitting bloodborne viruses such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) (CDC 2011).

In order to prevent infection transmission, you should:

• Never use the same lancet device for multiple clients, even if the needle is changed and the device is cleaned and disinfected
• Change gloves if you come into contact with lancet wounds or objects that are potentially contaminated with blood. Do this before touching any clean surfaces
• Use an alcohol-based hand rub or soap and water:
  • If your hands become visibly soiled
  • After you finish contact with a client
  • After coming into contact with blood or body fluid
  • Before touching equipment that is intended to be used for other clients
• Immediately discard used lancet devices into a sharps container after use
• Always change your gloves and perform hand hygiene between attending to different clients
• Clean and disinfect the blood glucose meter after every use (refer to the manufacturer’s instructions)
• Ensure the blood glucose meter is approved for use on multiple people before using it on another client
• Follow equipment cleaning and disinfection procedures.

(Minnesota DoH 2018; CDC 2011)

Sharps and Waste Disposal

Read: Healthcare Waste: Collection, Storage and Disposal

Lancets must always be disposed of into a designated sharps container. Never discard them into a general rubbish bin (NDSS 2015). Testing strips should be discarded into an appropriate body fluids bin provided by your organisation.

Note: This article is intended as a guide only for non-clinical staff who are required to monitor blood glucose levels in home care clients and should not replace best-practice care. Always refer first to your organisation's policies and procedures on blood glucose monitoring.

Additional Resources

• Diabetes Australia
• National Diabetes Services Scheme
• Healthcare Waste: Collection, Storage and Disposal | Ausmed Article

References

• Centers for Disease Control and Prevention 2011, Infection Prevention During Blood Glucose Monitoring and Insulin Administration, CDC, viewed 8 June 2021, https://www.cdc.gov/injectionsafety/blood-glucose-monitoring.html
• Diabetes Australia 2019, Blood Glucose Monitoring, Diabetes Australia, viewed 8 June 2021, https://www.diabetesaustralia.com.au/living-with-diabetes/managing-your-diabetes/blood-glucose-monitoring/
• Diabetes Australia 2015, Hyperglycaemia, Diabetes Australia, viewed 8 June 2021, https://www.diabetesaustralia.com.au/living-with-diabetes/managing-your-diabetes/hyperglycaemia/
• Diabetes NSW & ACT 2020, Blood Glucose Monitoring and Diabetes, Diabetes NSW & ACT, viewed 8 June 2021, https://diabetesnsw.com.au/blog/blood-glucose-monitoring-and-diabetes/
• Healthdirect 2020, Diabetes Testing and Monitoring, Healthdirect, viewed 8 June 2021, https://www.healthdirect.gov.au/diabetes-testing-and-monitoring
• Minnesota Department of Health 2018, Checklist to Ensure Safe Injection Practices During Blood Glucose Screening, Minnesota Department of Health, viewed 8 June 2021, https://www.health.state.mn.us/facilities/patientsafety/injectionsafety/glucoseischeck.pdf
• National Diabetes Services Scheme 2015, Blood Glucose Monitoring, NDSS, viewed 8 June 2021, https://www.ndss.com.au/living-with-diabetes/managing-diabetes/blood-glucose-monitoring/
• National Diabetes Services Scheme 2020, Blood Glucose Monitoring Fact Sheet, NDSS, viewed 8 June 2021, https://www.ndss.com.au/about-diabetes/resources/find-a-resource/blood-glucose-monitoring-fact-sheet/
• Victoria Department of Health 2018, Hypoglycaemia: Standardised Care Process, Victorian Government, viewed 8 June 2021, https://www.latrobe.edu.au/__data/assets/pdf_file/0005/1152455/SCP-Hypoglycaemia.pdf