Assessing and responding to sudden deterioration in the adult
Nicola Neale, Joanne Sale in Developing Practical Nursing Skills, 2022
Blood glucose monitoring is part of the daily routine of many people with diabetes, who know their normal blood glucose levels and are aware of how to control their blood glucose. In Enid’s instance, her carers know her usual blood glucose level and will be monitoring this, highlighting any abnormality to the health professionals. When a person becomes unwell due to infection, disease, trauma or a mental health problem, they may be unable to control their diabetes. Blood glucose levels are measured by carrying out a finger prick and gaining a blood sample, which is then analysed using a glucose meter. There are different types of glucose meters available. Alternatively, a blood sample can be taken to the biochemistry laboratory for analysing glucose levels. This test usually takes a little time to perform and is therefore not useful in an emergency situation. Treatment will need to be administered according to the blood glucose level. Box 14.59 lists key points in blood glucose measurement.
Endocrine disorders
Anne Lee, Sally Inch, David Finnigan in Therapeutics in Pregnancy and Lactation, 2019
Regular home blood glucose monitoring is necessary if good diabetic control is to be achieved. Insulin does not cross the placenta but metabolic disturbances due to excess or lack of insulin will affect the fetus. Hypoglycaemic attacks are more common during pregnancy. Tight glycaemic control is usually achieved with a combination of separate soluble and medium- or long-acting insulins as this provides better flexibility than fixed combination products. This is either given as a twice-daily combination of short- and long-acting insulin or as multiple daily injections of short-acting insulin prior to meals with a long acting insulin at bedtime. It is outside the scope of this book to give detailed guidance on individual insulin regimes, expert advice from a diabetologist should be obtained.
Medical complications of pregnancy
Louise C Kenny, Jenny E Myers in Obstetrics, 2017
Women with diabetes should be managed throughout their pregnancy by a multidisciplinary team involving diabetic specialist midwives and nurses, a dietician, an obstetrician and a physician. The primary goal of the team is to support the woman and her family during the pregnancy to safely optimize glycaemic control. Blood glucose monitoring is encouraged 7 times a day (before and 1 hour after meals) with targets of <5.3 mmol/l and 1-hour postprandial levels of <7.8 mmol/l. If not given before pregnancy, women require additional support and education regarding diet, use of oral hypoglycaemic agents such as metformin where appropriate, insulin adjustments for hyperglycaemia and management of hypoglycaemia, which is much more common and potentially very dangerous in pregnancy, particularly in women with reduced hypoglycaemic awareness.
Managing diabetes at the end of life – a retrospective chart audit of two health providers in Queensland, Australia
Published in Progress in Palliative Care, 2019
Naeema Alqabandi, Alison Haywood, Korana Kindl, Sohil Khan, Phillip Good, Janet Hardy
BGL monitoring in these situations can be considered as a lifesaving tool. Frequent BGL monitoring with a frequency range 1–6 times a day is essential, particularly in patients with hypoglycaemia unawareness who are unlikely to report the early warning symptoms of hypoglycaemia. One of the preventive strategies that has been proposed is frequent blood glucose monitoring. Unless the patient's glycaemic control is stable, BGL monitoring should be continued.23 Some would argue that the finger-prick test is impractical to conduct in this population. However, findings from the present study suggest ease of adaption to finger-prick testing or the use of an alternative testing site such as the palm, the arm or forearm. Only one patient refused BGL monitoring a few times within this study. Additionally, new high technology sensor devices have been released commercially which make blood glucose reading easier. A recent study supported the effectiveness of these devices in improving outcomes in type 1 patients, however their use was limited due to high cost.24
MiniMed 670G hybrid closed loop artificial pancreas system for the treatment of type 1 diabetes mellitus: overview of its safety and efficacy
Published in Expert Review of Medical Devices, 2019
Aria Saunders, Laurel H. Messer, Gregory P. Forlenza
In addition to replacing insulin, individuals with T1D must also monitor their glucose levels. This can be done by blood glucose monitoring, or using a Continuous Glucose Monitor (CGM). CGMs are subcutaneous electrochemical sensors which measure the glucose levels of the interstitial fluid [6]. The sensor is connected to a transmitter that continuously transfers current blood glucose readings to a portable device or directly to the pump every five minutes, and will alert users if glucose levels exceed hyperglycemia or hypoglycemia thresholds [6]. Many types of CGM devices require multiple calibrations per day from a blood glucose meter value to improve accuracy [7]. More advanced models of insulin pumps also allow for integration with continuous glucose monitor (CGM) sensors providing patients with a real-time value of their current blood glucose on the pump [6]. CGM sensors are inserted under the skin by the patient and worn for 7–10 days before being replaced with a new sensor.
Comparative efficacy and safety of two insulin aspart formulations (Rapilin and NovoRapid) when combined with metformin, for patients with diabetes mellitus: a multicenter, randomized, open-label, controlled clinical trial
Published in Current Medical Research and Opinion, 2022
Jun Yao, Xiaohui Guo, Li Sun, Ping Han, Xiaofeng Lv, Xiuzhen Zhang, Zhaohui Mo, Wenying Yang, Lihui Zhang, Zhanjian Wang, Lvyun Zhu, Quanmin Li, Tao Yang, Wenbo Wang, Yaoming Xue, Yongquan Shi, Juming Lu, Yongde Peng, Fan Zhang, Dewen Yan, Damei Wang, Xuefeng Yu
Hypoglycemic events were recorded by patients in their daily log, including all blood glucose values of ≤3.9 mmoI/L (70 mg/dL) or values of >3.9 mmol/L (70 mg/dL) if they were accompanied by hypoglycemia symptoms. Hypoglycemia episodes were categorized based on American Diabetes Association classifications19,20. These included severe hypoglycemia (an event that required help from others to effectively administer carbohydrates, glucagon, or other recovery measures); documented symptomatic hypoglycemia (an event accompanied by typical hypoglycemia symptoms and blood glucose measured at ≤3.9 mmol/L [70 mg/dL]); asymptomatic hypoglycemia (an event not accompanied by typical hypoglycemia symptoms, but with blood glucose measured at ≤3.9 mmol/L [70 mg/dL]); probable symptomatic hypoglycemia (an event with hypoglycemia symptoms, but no blood glucose monitoring value) and relative hypoglycemia (an event when the patient reports typical hypoglycemia symptoms and interprets them as a manifestation of hypoglycemia, but with blood glucose measured at >3.9 mmol/L [70 mg/dL]). There was an additional classification of a mild hypoglycemic event defined as a blood glucose value of <2.8 mmol/L (50 mg/dL) with no symptoms or symptoms that the patient was able to manage by themselves. Only hypoglycemic events meeting the criteria for an SAE (AEs requiring new or prolonged hospitalization, which lead to permanent disability, impact the ability to work, or are life-threatening) were recorded as AEs.
Related Knowledge Centers
- Diabetes
- Glucose
- Skin
- Glucose Meter
- Blood Sugar Level
- Diabetes Management
- Fingerstick
- Continuous Glucose Monitor
- Fasting
- Random Glucose Test