bedside blood glucose

Question 1

equipment

Answer 1

Glucose meter method
Equipment: - Blood glucose meter
Test strips
Lancet/spring loaded finger prick device
Alcohol swab
Non-sterile gloves
Cotton wool ball
Watch

Question 2

intro and setup

Answer 2

1. Collect equipment and ensure the test strips are in date. The machine should also be calibrated for
   use with that particular batch of strips according to manufacturers instructions. (This involves
   matching a code number on the strip bottle to the code registered on the meter).
2. Check patient’s details, introduce yourself and explain what you’re about to do – obtain consent.
3. Wash hands and don a clean pair of non-sterile gloves - ensure the patient has also washed their
   hands or swab chosen finger with alcohol swab.
4. Turn on the blood glucose meter and calibrate.

Question 3

doing the test

Answer 3

6. Once the meter is ready for use (as each machine will be different ensure you have read the
   manufacturers instructions for use before you begin), use the lancet prick the patient’s finger lateral to
   the fingertip. (Try and avoid the thumb, forefinger and fingertips). Don’t choose a finger that has been
   tested recently.
7. Squeeze the finger to obtain a large drop of blood. Apply the drop of blood to the appropriate area
   on the test strip.
8. Insert the test strip into the machine according to the manufactures recommendations. Some may
   require the blood to be wiped off before hand others may not.
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9. Allow the machine to analyse the blood. In some meters this can take up to 60 seconds.
10. While waiting, clean the patient’s fingers.

Question 4

clear up

Answer 4

12. Once the analysis is complete record the results.
13. Dispose for lancet and test strip as appropriate.
14. Remove the gloves and wash hands.
15. Take appropriate actions according to results.

Visually-read strip method
This is exactly as above, but when you’ve got the blood on the strip you have to leave it for 60s, wipe
and then read the strip against a visual check card.

Question 5

Why do you get the patient to wash their hands?

Answer 5

To prevent infection (though unlikely) and to remove any traces of glucose from the fingers.

Question 6

If the test result was 8.0mmol/l, what significance would you attach to this?

Answer 6

You can’t attach any significance to it without knowing whether the measurement was a fasting
glucose or not. Glucose should really be measured before breakfast or just before a main meal.

Question 7

If the fasting blood glucose was 8.0mmol/l, what significance would you attach to it and what further
action should you take?

Answer 7

This result is compatible with diabetes, but an abnormal finger prick test must be confirmed by
laboratory measurement before diagnosis, and maybe also an oral glucose tolerance test.

Patients may be transiently hyperglycaemic during an acute illness such as pneumonia – a
fasting BM needs to be repeated when the patient is over the illness.

If the patient was diabetic, a fasting glucose of 8.0mmol/l is moderate, though not ‘perfect’
glycaemic control. A dietician should advise them on a sugar-free diet, notify the GP and
arrange an OP follow up.

Question 8

diagnosis of diabetes:

Answer 8

Some revision re: diagnosis of diabetes:

Fasting glucose; 2-hour glucose; Interpretation

> 7.0; or >11.1; Diabetes mellitus
6.1 and 7.8 and 6.1 and

Question 9

indications for OGTT

Answer 9

Most patients do not need an oral glucose tolerance test (OGTT), but those with IFG on fasting
glucose do. Another indication for OGTT is when you get 2 disconcordant fasting glucose tests.
In symptomatic individuals, diabetes is confirmed by one of the following:
*Random plasma glucose of >11.1mmol/l
*Fasting plasma glucose >7.0mmol/l
*OGTT 2-hour value of >11.1mmol/l (on follow up of IFG)
NB. Blood glucose is 10% less than that of plasma glucose.

Question 10

Performing an oral glucose tolerance test

Answer 10

1. Introduce self to patient, explain what is going to happen and why you want to do the test - gain
   consent. OGTT is reserved for true borderline cases of DM2.

2 - The patient needs to fast overnight. After the fast, 75g of glucose is taken in 250-350ml of water.

3. Blood samples are taken in the fasting state and two hours after the glucose has been given.
4. A specific enzymatic glucose assay must be used.
5. See above for interpretation.