Only As Good As Their Maintenance, Remember to Calibrate and Calibrate Frequently
Jul 11 '01
The Bottom Line Glucose monitors are an important tool in controlling diabetes, however they must be maintained properly and their reading correlated with clinical symptoms to be useful.
Hello Everyone,
Writing this epinion from the perspective of a Medical/Surgical Registered Nurse, working in a hospital who deals with hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) on a daily basis.
Will focus on a few topics including:
1. What is Diabetes? Why Test in The First Place?
2. Symptoms/Effects of Hypoglycemia.
3. Symptoms/Effects of Hyperglycemia.
4. Guidelines for using a glucose monitor.
5. When not to trust your glucose monitor.
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1. What is Diabetes? Why Test in The First Place?
Diabetes is a disease where the levels of blood sugar in the bloodstream are not regulated properly by the body allowing abnormally high and low values.
This can be due to a total lack of insulin production (common in Insulin Dependent Diabetes, Type I) or poor insulin production combined with lack of effect (on lowering blood sugar, Non Insulin Dependent Diabetes, Type II).
(Insulin is a hormone that allows the body to take glucose in the blood from food and use it for energy in the individual cells.)
Without the right amount of insulin, or effective insulin action, blood sugar levels can rise or fall to dangerous levels.
These high blood sugar levels have been linked to coronary heart disease, peripheral vascular disease, blindness, kidney failure and a host of other diseases that might otherwise be avoided by keeping blood sugar within normal levels.
By monitoring their blood sugar frequently, Diabetics can be sure they’re getting the right balance of food and insulin to maintain their sugar in a safe range.
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2. Symptoms/Effects of Hypoglycemia.
A normal blood sugar range for most people is 60-120 mg/dl. In a Diabetic, their normal body functions that will maintain this range are not functioning. If the blood sugar falls below 60 mg/dl, then the brain (which depends solely on glucose to survive) can be affected.
Symptoms of hypoglycemia can be different in different people but generally include:
a. Change in mood or mental status: Some patients can become grouchy, or sleepy or display behavior that is not their normal.
b. Diaphoresis: The body will respond to the low blood sugar by sweating heavily, regardless of the temperature in the room.
c. Coma, lethargy, brain damage and death: The lower a person’s blood sugar goes, and the longer it stays low, the higher the risk of the brain “starving” and starting to die. Once the brain runs out of fuel (glucose), portions of it will start to malfunction and then brain tissue can die leaving permanent damage.
If you suspect that a person is going hypoglycemic, and they are unable or unwilling to take sugar or food by mouth, call for emergency medical services ASAP.
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3. Symptoms/Effects of Hyperglycemia:
When a person’s blood sugar reaches dangerously high levels, two common conditions can occur (please visit these websites for more info):
Diabetic Ketoacidosis (http://www.embbs.com/cr/dka/dkankh.html) and Hyperosmolar Hyperglycaemic Nonketotic Coma (http://zurba.com/dm/hhnk.htm)
Both of these conditions are life threatening and involve blood sugar readings typically over 500 mg/dl
Most glucose monitors have a high limit of 500 or 600 mg/dl, above which they’ll simply read “high.” If you get this reading, try re-calibrating your monitor if it’s been a while and verify the result.
Typically, in hyperglycemia, you’ll have the three “Ps” present:
Polyuria (excessive urination) Polydipsia (excessive thirst) and Polyphagia (excessive hunger).
Lethargy (drowsiness), warm flushed skin and other symptoms may be present.
Again if symptoms are present along with a high reading, bring the person to the Emergency Department or call 911 if you suspect dangerously elevated blood sugar levels.
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4. Guidelines for using a Glucose Monitor.
First, the monitors used in either a hospital or your home are only as good as the maintenance they receive.
Even the most expensive and sophisticated glucose monitor will not work properly if neglected.
In the hospital and with home kits, monitors come with control solutions, that are known to give high or low readings when the glucose measuring device is working properly.
It's common practice for quality assurance for monitors to be done daily or at set intervals. That is they run tests with the solutions knowing the result should be a high or low value.
When they do the tests and do not get the expected values, it's time for that piece of equipment to be taken out of service and sent for repair.
On a busy nursing unit when nurses are busy keeping people alive and dealing with emergencies, sometimes this quality assurance "step" can be skipped.
Both commercial glucose monitors used in hospitals and test kits sold to consumers come with these controls. Be sure you are familiar with them and use them as recommended by the manufacturer to make sure your readings are accurate.
Checking a person’s blood sugar is a relatively simple procedure with most modern glucometers.
In a nutshell, after verifying that it’s calibrated properly, blood is obtained (usually by pricking a finger with a lancet) and applied to the test strip.
Within a few seconds to a few minutes depending on the monitor, a reading will be given.
Before pricking the finger for a blood sample, the hand should be washed with soap and water (In the hospital we usually swab the finger with an alcohol pad).
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5. When not to trust your glucose monitor.
In the healthcare field as in life, you learn to trust your instincts. When things don’t quite look right, investigate a little further.
A high or a low blood sugar level by itself may indicate a problem with a person’s blood sugar or a problem with a glucose monitor.
In the case of a person’s blood sugar, there are usually tell-tale signs and symptoms indicative of a dangerous glucose level.
Your best defense is to educate yourself on the signs and symptoms of high and low blood sugar. Make sure both the patient and the family members caring for a patient (or nearby neighbors) are aware as well. In some diabetic emergencies, the patient might be unconscious and unable to tell you what is wrong.
If in doubt of whether a blood sugar reading is accurate or not, look for clinical signs or symptoms of either high or low blood sugar. Try to remain calm (It could just be a false high or low).
Do a second or third reading to verify the first result.
If that doesn’t help or if the patient is symptomatic, dial 911 or call your doctor/emergency department for help.
For more information on diabetes, please visit:
http://www.nursefriendly.com/diabetes/
Sincerely,
Andrew Lopez, BS RN
The Nursefriendly National Nursing & Consumer Healthcare Directories
http://www.nursefriendly.com, andypulse2@aol.com ICQ #6116137, AOL “andypulse2”
867 Dante Court, Mantua New Jersey 08051
856-415-9617, (fax) 415-9618
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