Glucose Monitoring Insulin Administration

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Glucose MonitoringInsulin Administration
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• Blood glucose monitoring is a cornerstone of
  diabetes management
• Self Monitoring of blood glucose (SMBG) enables
  optimum control

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SMBG

• Various methods available
• Use whole blood or plasma
• Obtain drop of blood from fingertip or forearm
• Apply blood to special reagent strip
• Meter gives a digital readout

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Sources of Error

• Improper application of blood
• Improper meter cleaning and maintenance
• Damage to reagent strips by heat or humidity
• Use of outdated strips

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Values for Normal Blood
Glucose

• Smeltzer - 60 - 100 mg/dL
• Fischbach - 65 - 110 mg/dl

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Other Methods To Test Glucose

• Visual method
• Urine glucose testing

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Disadvantages to Urine Glucose Testing

• Does not accurately reflect blood glucose level
  at the time of test
• Renal threshold for glucose is 180 - 200 mg/dL
• Hypoglycemia can not be detected
• Various drugs interfere with results

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Testing for Ketones

• Ketone bodies are byproducts of fat breakdown
• Occurs when insulin is not available for cells to
  utilize glucose
• Methods of testing
• Ketostix
• Meter
• Should be performed when SMBG levelsgt240 mg/dL

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Points to Remember When Checking Blood Glucose

• Follow universal precautions
• Wash clients hands with warm soap and water
• Prick outer edge of finger
• Touch reagent pad to finger only once
• Keep record or log

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Frequency of SMBG

• Clients receiving insulin - 2 - 4 X day
• Clients not receiving insulin - 2 -3 X week
• Test whenever hypoglycemia or hyperglycemia
  suspected

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Antidiabetic drugs are

• Used primarily to control diabetes mellitus, a
  chronic disease that affects carbohydrate
  metabolism
• Two groups of antidiabetic drugs

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Insulin

• Released from beta cells of the islets of
  Langerhans
• Facilitates the uptake and utilization of glucose
  by the cells
• Exogenous insulin previously produced from pork
  and bovine pancreas
• Currently produced by recombinant DNA technology
• Different types of insulin

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Important Points to Remember About Insulin

• Grouped based on onset, peak, duration
• Rapid and short acting insulins are clear
• Intermediate and long acting insulins are cloudy,
  except Lantis
• Lantis is clear, taken at bedtime and can not be
  mixed with other insulins
• Encourage patients to keep a spare bottle in the
  refrigerator

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Storage of Insulin

• Unopened vials are refrigerated until expiration
  date
• Once opened, vial may be stored
• At room temp X 1 month
• In refrig X 3 months
• Prefilled syringes X 3 weeks

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• Avoid storage areas near direct sunlight or heat
• Never freeze insulin

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Insulin Regimens

• May receive if Type 1 or Type 2
• Varies from client to client
• Usually 1 - 4 injections daily
• Usually a combination of rapid/short acting and
  longer acting
• May have set dose of daily insulin
• Frequently have sliding scale coverage for
  elevated glucose levels

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Rotating Injection Sites

• Recommended to prevent localized changes in fatty
  tissue
• Four main areas for injection
• Abdomen
• Posterior arms
• Anterior thighs
• Hips

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• Do not inject in a limb to be exercised
• ADA recommends using all available injection
  sites within one area
• Another approach use same area at same time of
  day
• Administer 1 away from previous site
• Do not use same site more than once in 2-3 weeks

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Complications of Insulin Therapy

• Local allergic reactions
• Redness, swelling, tenderness at injection site
  1-2 hrs after injection
• Less common with human insulins
• Disappears in time
• Physician may prescribe antihistamines 1 hr
  before injection

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• Systemic allergic reactions
• Rare
• Immediate local skin reaction which progresses to
  urticaria
• Occasionally generalized edema and anaphylaxis
• Treat with desensitization

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• Lipodystrophy
• Lipoatrophy - loss of fat tissue that appears as
  dimpling or pitting
• Lipohypertrophy - development of fibrofatty masses

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• Insulin resistance - large amounts of insulin are
  required to control glucose.
• Contributing factors
• Obesity
• Animal insulins
• Treat by losing weight and by giving more
  concentrated insulins or steroids

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• Hypoglycemia - abnormally low glucose levels
  usually less than 60mg/dL
• Causes
• Too much insulin or oral hypoglycemic meds
• Too little food or delayed meal
• Excessive physical activity

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Clinical Manifestations of Hypoglycemia

• Mild hypoglycemia
• Sweating
• Tremors
• Tachycardia, palpitations
• Hunger

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• Moderate hypoglycemia
• Headache
• Lightheadedness
• Confusion
• Slurred speech
• Impaired co-ordination
• Blurred vision
• Numbness of lips and tongue

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• Severe hypoglycemia
• Disoriented behavior
• Difficulty arousing
• Seizures
• Coma and death

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Treatment of Hypoglycemia

• Assess client
• Check glucose with meter
• Administer 15 gms of fast acting carbohydrate
• 3 glucose tablets
• 4 oz of fruit juice or soda
• 1 cup skim milk
• 1 tbsp honey or sugar
• Retest glucose in 15 minutes
• If less than 70-75 mg, repeat CHO
• Administer snack with protein and starch or eat
  regular meal