MIDTERMS

• Insulin


  Hormone produced by the pancreas, controls the level of glucose in the blood by regulating the production and storage of glucose
• Classification of Diabetes


  • Type I Diabetes: insulin-dependent diabetes mellitus
  • Type II Diabetes: non-insulin dependent diabetes mellitus
  • Gestational Diabetes
  • Diabetes mellitus associated with other conditions or syndromes
• Type 1 diabetes


  • Characterized by destruction of the pancreatic beta cells
  • Genetic susceptibility is a common underlying factor in development
  • Destruction of beta cells results in decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia
  • Excess glucose is excreted in the urine, it is accompanied by excessive loss of fluids and electrolytes which is called "Osmotic Diuresis"
• Type II diabetes mellitus

  • Insulin resistance and impaired insulin secretions
  • Insulin resistance refers to a decreased tissue sensitivity to insulin
  • To overcome insulin resistance and to prevent the build up of glucose in the blood, increased amounts of insulin must be secreted to maintain the glucose level at a normal or slightly elevated level
  • DKA (Diabetic Ketoacidosis) does not typically occur in type II diabetes because there is enough insulin present to prevent the breakdown of fat and the accompanying production of ketone bodies
• Gestational Diabetes


  • Any degree of glucose intolerance with its onset during pregnancy
  • Hyperglycemia develops during pregnancy because of the secretion of placental hormones, which causes insulin resistance
  • Screening for diabetes during pregnancy is recommended between the 24th - 28th weeks of gestation, 25 years old and above, 25 years or younger and obese, family history of DM in first-degree relatives
  • After delivery of the infant, blood glucose levels in the woman with gestational DM return to normal
• Blood Glucose Monitoring


  Measures blood glucose levels for monitoring control of diabetes mellitus
• Blood Glucose Monitoring


  • Test results direct diet, amount and type of medication, exercise prescription
  • Helps prevent diabetic emergencies by prompt detection & treatment of hypo- & hyperglycemia
• Capillary Blood Glucose Monitoring (CBG Monitoring/ Self Monitoring of Blood Glucose - SMBG)

  • Blood glucose monitoring is a cornerstone of diabetes management and SMBG levels by patients has dramatically altered diabetes care
  • Frequent SMBG enables people with diabetes to adjust the treatment regimen to obtain optimal blood glucose control. This allows for detection and prevention of hypoglycemia and hyperglycemia and plays a role in normalizing blood glucose levels, which in turn may reduce the risk of long term diabetic complications
• CBG monitoring/ SMBG


  1. Obtaining a drop of blood from the fingertip

  2. Applying the blood to a special reagent strip

  3. Allowing the blood to stay on the strip for the amount of time specified by the manufacturer (usually 5-30 seconds)

  4. The glucometer gives a digital readout of the blood glucose value
• ac and hs


  Performed usually before meals and at bedtime
• Why should the BGL be assessed before a meal?
• Each facility has a slightly different procedure. You will have to be validated at each facility for this procedure.
• Know the Normal values for blood glucose.
• Report values outside of the range of normal ASAP...very important as immediate intervention is usually indicated.
• You will usually repeat the test if you get a value outside of the range of normal.
• Know the values at which the monitor you are using is no longer accurate: CBG less than 80 and greater than 120.
• If the BGL if less than 90 you MUST intervene immediately. Don't wait on your clinical instructor to come to you...find her or another RN.
• Diabetes


  • Inability of the pancreas to either produce enough insulin or the body's inability to utilize the insulin it has
  • Insulin is the substance that converts glucose to a form that is usable by the body
  • Low insulin equal high glucose circulating in the blood but not utilized by the cells
• Hypoglycemia


  Low blood sugar, hyperinsulinemia
• Hyperglycemia


  Elevated blood sugar, Inadequate insulin
• Symptoms of Hypoglycemia


  • Sweating
  • Tachycardia
  • Palpitations
  • Nervousness
  • Tremors
  • Weakness
  • Headache
  • Mental confusion
  • Fatigue
• Symptoms of Hyperglycemia


  • Thirst
  • Polyuria
  • Polyphagia
  • Weakness
  • Fatigue
  • Headache
  • Blurred vision
  • Nausea
  • Vomiting
  • Abdominal cramping
• Complications of Abnormal Blood Glucose

  • Heart attack
  • Cerebrovascular accident
  • Kidney dysfunction
  • Blindness
  • Nerve damage
• Blood Glucose Monitoring - Assessment


  • Client's understanding
  • Health history
  • Specific conditions of specimen collection
  • Site selection
  • Client's ability to self-test
  • Presence of signs & symptoms glucose alteration
  • Calibration of equipment
• Blood Glucose Monitoring - Planning


  • Expected outcomes focus on minimizing tissue damage with finger stick, achieving accurate results, and maintaining glucose levels within goal range
• Blood Glucose Monitoring - Equipment

  • Glucometer
  • Gloves
  • Antiseptic swab
  • Cotton ball or gauze
  • Sterile lancet
  • Paper towel
  • Sharps box
  • Test strips
• Blood Glucose Monitoring - Implementation

  1. Wash hands

  2. Position site lower than heart

  3. Gather supplies and turn on meter

  4. Select site and cleanse

  5. Position lancet firmly against site and pierce skin

  6. Collect sample

  7. Read results
• Lancing Devices


  • Lancets
  • Pen-type Lancing Devices
  • MultiClix
• Meter


  • Features vary: sample size, wait time, alternate-site testing capacity, communication with other devices – pumps, continuous glucose monitors
  • Become familiar with operation of meter
  • 1-800 number on back of meter
• Preparation


  1. Gather blood glucose monitoring supplies: lancet, test strips, meter

  2. Student washes hands and dries thoroughly

  3. If assisting or performing for student, put on disposable gloves
• Readying the Meter


  1. Turn the meter on

  2. Check code # (if required)

  3. Insert a strip into the meter
• Lancing the Finger


  1. Hold the lancet device to the side of the finger and press the button to stick the finger

  2. Alternative site: the school nurse and/or parent/guardian will give further instructions which sites are appropriate

  3. Note: In the case of suspected hypoglycemia, only the finger should be used for blood glucose sampling
• Applying Blood to Strip

  1. Drop, not smear

  2. Cover ALL of test strip window

  3. Some strips wick blood onto the strip

  4. Follow instructions included with the meter when applying blood to strip
• Results


  1. Wait until blood glucose results displayed

  2. Dispose of lancet and strip

  3. Record blood glucose results, take action
• Blood Glucose Monitoring - Evaluation


  • Observe site for bleeding or bruising
  • Compare client readings with normal values
  • Ask client to discuss procedures & test results
  • Observe client performing self-testing
• What if: Puncture site continues to bleed, Glucose meter malfunctions, Result is above or below normal value, Client expresses misunderstanding of procedure or results
• Factors affecting SMBG/ CBG monitoring

  • Visual Acuity
  • Fine motor coordination
  • Cognitive ability
  • Comfort with technology
  • Willingness
  • Cost
• Monitoring blood glucose using meters is recommended because meters have become much less expensive and less technique-dependent, making results more accurate.
• Potential Hazard of SMBG/ CBG monitoring

  • Improper application of blood (ex.: drop too small)
  • Improper meter cleaning and maintenance (ex.: allowing dust or blood to accumulate on the optic window). Thus is not an issue in the biosensor type of meter.
  • Damage to the reagent strips by heat or humidity; use of outdated strips
• The nurse plays an important role in providing initial teaching on how to use it properly. Every 6-12 months, patients should conduct a comparison of their monitoring with a simultaneous laboratory-measured blood glucose level in their attending physician.