Instruct carers and clients on the best way to take a BGL measurement
Maintain best practice care and safety of our diabetic and pre-diabetic clients
Background
Optimal glycaemic control helps to reduce the development and progression of diabetes-related complications.
Monitoring helps us and our clients see the effects of food, exercise, medication and illness on their blood glucose levels. This will then help our clients and families make the best decisions around:
Food (types and quantities)
Physical activity
Medications, especially when our client starts or changes medication
Driving (Road and Maritime Service recommendation is to have a blood glucose level above 5 to drive)
How often we monitor our client's target range is highly individualised and depends on many factors. Please see the client's file for further information.
Common Glucose Level Targets
Before meals (fasting), 6-8 mmol/L
After meals (2 hours after starting meal), 6-10 mmol/L
NB:These samples may be different levels for your client.
Blood glucose levels are measured in millimoles per litre (mmol/L). Target ranges may differ depending on the client's age, duration of diabetes, the type of medication you are taking and if you have any other medical problems. The CCM should speak with the doctor about their target ranges.
Normal blood glucose levels are between 4.0–7.8mmol/L.
Blood Glucose Target Levels
Inconsistent highs and lows Sometimes you may see a lower or higher blood glucose reading than usual and be unable to figure out why. When clients are sick with a virus or flu, their blood glucose levels will nearly always increase, and the CCM may need to contact their doctor. Several other common causes for blood glucose levels to increase or decrease include:
Food – time of eating, type and amount of carbohydrate, for example, bread, pasta, cereals, vegetables, fruit and milk
Exercise or physical activity
Illness and pain
Diabetes medication
Alcohol
Emotional stress
Other medications
Blood glucose checking techniques.
Contact the CCM if the client's blood glucose patterns change or are consistently higher or lower than usual.
Getting accurate results There are many reasons why the results of their blood glucose checks could be inaccurate. The best defence against this is to speak with the CCM to ensure you know how to use the glucometer, prepare the lancing site, and maintain the meter and equipment.
What if the blood glucose check result doesn’t sound right? If you’re not convinced that a result is correct, here’s a suggested checklist:
Have the strips expired?
Is the strip the right one for the meter?
Is there enough blood on the strip?
Has the strip been put into the meter the right way?
Have the strips been affected by climate, heat or light?
Did you wash and thoroughly dry your hands before doing a check? (Handling sweet foods such as jam or fruit can give higher results)
Is the meter clean?
Is the meter too hot or too cold?
Is the calibration code correct?
Is the battery low or flat?
All meters will give a different result with a different drop of blood. As long as there is no big difference (more than 2mmol/L), there is not usually cause for concern.
The accuracy of all meters can be checked with meter-specific liquid drops called control solutions. You can check the meter with a control solution if you are concerned. Ask the CCM to contact the pharmacist to help you with this.
Caring for test strips It is essential to care for the client's test strips so that they get an accurate reading. To do this, refer to the manufacturer’s instructions. It will include recommendations like:
Storing them in a dry place
Replacing the cap immediately after use
Checking the expiry date is valid.
Checking BGLs will help you to:
Develop confidence in helping the client to look after their diabetes.
Better understand the relationship between their BGLs and exercise, food and other lifestyle influences such as travel, stress and illness.
Know how lifestyle choices and medication, if used, are making a difference.
Check care instructions to determine if their BGLs are too high (hyperglycaemia) or too low (hypoglycaemia). Immediately, verbally advise the CCM, who will contact the client's doctor. The BGLs you record will assist the doctor in making crucial decisions for the client, such as eating before exercise, how to treat a ‘hypo’ or seeking medical advice if sick.
CCMs are to know when to seek the advice of the client's diabetes health team about adjusting insulin, tablets, and meal or snack planning when blood glucose goals are not being met.
How do I check my client's glucose levels? Refer to the blood glucometer’s instructions on monitoring the client's blood glucose levels. It is important to follow the instructions provided by the CCM in the care instructions related to measuring and recording the client's BGLs.
Their doctor or credentialled Diabetes Educator will help them decide how many checks are needed and the desired levels. When and how often you should check their blood glucose levels varies depending on each individual, the type of diabetes and the tablets and/or the insulin being used. Blood glucose levels are measured in millimoles per litre (mmol/L).
Keeping a record of their blood glucose levels can be very helpful for them and their doctor. You can help them keep a diary or use a mobile phone app or website to record their levels.
When should I check the client's blood glucose level? When and how often you should check blood glucose levels varies depending on each individual, the type of diabetes and the tablets and/or the insulin being used. The client's doctor will help them decide how many necessary checks and the levels to aim for, as detailed in the client's Care Instructions and Diabetes Management Plan. Possible times to check are:
Before breakfast (fasting)
Before lunch/dinner
Two hours after a meal
Before bed
Before rigorous exercise
When you are feeling unwell
When to measure BGLs
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View full-sizeDownload Even though the meter may have a memory, it is important to keep a record of the readings in a diary, and your client takes this with them to all appointments with their diabetes health team. This will provide them and their diabetes health team with vital information in deciding if and how their treatment may need to be adjusted.
Most meters on the market have software that allows you to download their records in different formats, such as graphs and charts. Even if you can do this, keeping a diary for their checks and details of their daily activities, the food they eat and other relevant information is still helpful. Some apps record all of this information in one place. Their CCM could ask their doctor or diabetes educator how to use a diary to help them manage their diabetes better.
Checking four times a day is recommended for people with type 1 diabetes. However, many people check more often, such as those using an insulin pump (CSII – Continuous Subcutaneous Insulin Infusion).
Times to check more often There will be times when you need to check more often with advice from the client's doctor. Examples of these times include when they are:
Being more physically active or less physically active
Sick or stressed
Experiencing changes in routine or eating habits, e.g. travelling
Changing or adjusting their insulin or medication
Experiencing symptoms of hypoglycaemia
Experiencing symptoms of hyperglycaemia
Experiencing night sweats or morning headaches
A female planning pregnancy or are pregnant.
Pre/post minor surgical day procedures
Post-dental procedures
Equipment
glucose testing strips
blood glucose monitor, a glucometer
lancet pen
lancets (individual or barrel)
sharps bin
gloves
Process
Wash the client's hands in warm soapy water and dry them well
Carer to wash hands and wear gloves
Prepare the blood glucose monitor, lancet pen (insert lancet or check barrel has a fresh lancet), glucose test strip, tissue and a sharps container.
Insert test strip in the metre (metallic end into the machine, follow arrow direction on the test strip)
Click the button on the lancet pen to load a fresh lancet from the lancet barrel.
Prick the finger on the side of the fingertip, not the fingertip pad, but not too close to the nail bed
Dispose of the lancet in a sharps container or cover the pen with the lid
When the symbol for "apply blood" appears, transfer blood to the test strip on a horizontal angle. The finger may require a small squeeze to get enough of a sample; the blood flows easily if the fingertip is below the person's waist
Repeat if there is an error or not enough blood
Discard the used test strip/s
Record the results in a BGL/BSL diary and/or shift notes
NB: If the client is unwell and the levels are significantly outside their preferred parameters, call CCM immediately for further advice.
Troubleshooting problems
If you suspect the reading is wrong, follow these steps:
Did the client wash and dry their hands well before you did the check?
Have the strips expired?
Is the strip the correct one for the meter?
Was there enough blood on the strip?
Did you put the strip into the meter correctly?
Have the strips been affected by climate, heat or light?
Is the meter clean?
Is the meter too hot or cold?
Is the battery low?
NB: Always check that the test strips are in date, and it is important that the strip container is closed as soon as possible after opening to avoid the pH levels changing.
Calibrating a BGL machine (glucometer)
If a glucometer is used less than once a month, carers need to calibrate it before each use.
If a glucometer is used regularly, the machine must be calibrated monthly.
Calibration instructions will vary for each glucometer and will require testing solutions that should come with the pack; read the instructions and follow the directions to calibrate the glucometer.
Or, Follow the instructions from the glucometer to calibrate the machine.
It normally will require using the testing solution as you would a blood sample, selecting which level it is (1 or 2- stated on the bottle), and waiting for a "correct" icon to occur. Record in shift notes when you have calibrated the glucometer.
NB: Ensure the test solution is in date and the first drop has been discarded before use.
Support Worker Responsibilities
Read the client's Diabetes Management Plan
Read the Diabetes Management Plan - Flow Chart (below)
Check BGLs as required with the correct technique
Calibrate the machine as needed
Inform CCMs of any changes or concerns around BGL readings
Record regularly and accurately according to the care instructions.
To explore this important link between Diabetes and daily life from Diabetes Australia. It describes the importance of diet, healthy exercise, mental health and technology around diabetes management.
Provide education and support around BGL monitoring and glucometer recalibrations
Liaise with GPs and other health professionals to remain up to date with client's diabetes management plan
Escalate any concerns around BGL readings appropriately.
Client Responsibilities
Ensure the correct equipment is in the home and in-date
Take their BGLs following the correct procedure if and when required
Be aware of their diabetes management plan and work towards their health outcomes
Glucometer Recalibrations It is important to maintain the glucometer to ensure that the BGL readings are accurate. Some clients have older glucometers that require recalibrating. The recalibration of the glucometer is a simple process and must be done at the completion of each container of blood glucose test strips. There is usually a calibrating device (similar to a micro USB) that is inserted into the glucometer and a special test strip that are provided when the glucometer was purchased. The items will be in the glucometer box or perhaps they have been stored in the glucometer kit. View this YouTube video to understand the process (3.01mins). Glucometer calibration |Blood Sugar Levels Glucometer Unit Calibration | Nurse on the Go Video
