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
Instruct the client to wash their hands in warm, soapy water and dry them thoroughly (to remove contaminants)
Perform hand hygiene and don gloves
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
Prick the side of the client’s fingertip with the lancet
Add a small drop of blood onto a blood glucose checking strip
The blood glucose meter will then display the client’s blood glucose level in millimoles per litre of blood (mmol/L)
Immediately dispose of the lancet in a sharps container
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.
Fasting/before meals
Two hours after starting meals
Type 1 diabetes
4–8mmol/L
<10mmol/L
Type 2 diabetes
6–8mmol/L
6–10mmol/L
(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Damaged or out-of-date testing strips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:
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
Always discard lancets into a designated sharps container.
Lancets must always be disposed of into a designated sharps container. Never discard them into a general rubbish bin (NDSS n.d.). 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.
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