721 Blood Glucose Testing

Required Reading

Handbook of Nonprescription Drugs, Chapter 47

Objectives

Nonprescription Products
  1. Demonstrate the steps in obtaining a blood glucose reading with a glucometer.
  2. Lay out all materials needed
  3. lancet w/new needle, alcohol wipes, glucose meter, reagent strip
  4. Clean all non-sterilized surfaces and wash hands with warm water
  5. load lancet new needle and set depth to proper setting
  6. deepest settinghealthy, thick skin
  7. lightest settingolder, thin skin
  8. allow hand to be punctured to hang down allowing blood to collect in hand
  9. clean potential site of puncture with alcohol wipe
  10. should choose side of finger as this contains fewest nerve endings
  11. puncture cleaned skin site with lancet allowing puncture site to swell with blood
  12. swelling should reach the approx. size of a pen tip
  13. if blood not swelling from wound attempt minor milking of site
  14. if not blood swell attempt puncture on alternate site following same method and should reset lancet for greater depth of puncture
  15. Present blood swell to the tip of the reagent slip. Do not place blood on strip. Allow capillary action to carry blood up the reagent slip. If enough blood is presented to strip, the reagent strip well will fill
  16. Insert reagent strip into the glucose monitor and allow the monitor to read level of glucose in blood
  17. Take reading and compare to known values
  18. Dispose of sharps to sharp’s container and wipe down instrumentation, lancet device and puncture site with alcohol. Wash hands
  19. types of meters
  20. Accu-check Active
  21. Ascensia Breeze
  22. Ascensia Elite
  23. Ascesia Elite XL
  24. Identify potential causes of inaccurate readings of a glucometer.
  25. application of to much blood to reagent strip
  26. aggressive milking
  27. use of blood from sites other than hands
  28. lack of frequent calibration
  29. fever, exercise, extremely hot weather, sauna, Jacuzzi all increase peripheral blood flow
  30. cold packs, cold extremities slow peripheral blood flow
  31. waiting to long to apply blood to reagent strip
  32. increased concentration of clotting factors
  33. Assemble typical products needed by an insulin dependent diabetic and describe the function of each.
  34. Insulin injection devices/Aids
  35. insertion aids
  36. a spring loaded jacket that fits over the filled syringe to guide the needle into the skin
  37. needle can be visible or not visible to px dependant on design of auto injector
  38. some adjust for depth and angle
  39. size of injector depends on type
  40. syringe can be prefilled and carried until ready to use
  41. insulin is temp sensitive
  42. insulin pens
  43. look like a writing pen
  44. use disposable or single use cartridges
  45. deliver preset or dial-in doses
  46. require only one hand for operation
  47. must remind px to replace disposable needle after every use
  48. jet injectors
  49. use pressure to force insulin under skin-no needle
  50. insulin disperses in the subcu layer
  51. regular needle creates bolus or a pocket of insulin that can only be absorbed on the pocket’s periphery
  52. first time insulin users must adjust their dose due to faster insulin adsorption
  53. error can occur if injector not held tightly to skin
  54. cause less lipotrophy and inflammation then needle
  55. infusers
  56. a small flexible catheter inserted and anchored into the subcu tissue
  57. px attaches syringe to port external to skin
  58. allows multiple doses of insulin to be given
  59. remain in place for 24-72 hrs
  60. px must take exceptional care of insertion site to prevent infection
  61. pump infusers
  62. require for tight control of blood glucose
  63. through injection as already discussed
  64. or, through pump at ~rate of 0.5-1.0 Unit/hr
  65. called open-loop
  66. no mechanical device constantly monitoring
  67. px must constantly monitor blood glucose
  68. at least four times per day
  69. px must determine how much insulin to inject
  70. Insulin
  71. Rapid actinghumalog (insulin Lispro), Novolog (insulin aspart)
  72. bolus given right before meals to handle the immediate increase in blood sugar
  73. short acting regular insulinHumulin R, Iletin II Regular, Novolin R
  74. bolus given right before meals to handle the immediate increase in blood sugar
  75. Intermediate-acting Lente InsulinHumulin L, Lente Iletin II, Novolin L
  76. establishes a basal level for most of the day
  77. zinc suspensions
  78. Intermediate-acting NPH insulin Humulin N, Novolin N, NHP Iletin II
  79. establishes a basal level for most of the day
  80. faster onset than Lente intermediate
  81. Isophane suspensions
  82. long actionLantus (insulin glargine), Humulin U Ultralentec
  83. extremely long acting(~24 hrs) basal dose
  84. use this for a steady state dose
  85. still use bolus dose ac
  86. Insulin Mixtures
  87. Humalog mix 75/25
  88. 75% insulin Lispro protamine sulfate: 25% insulin Lispro
  89. Humulin 50/50
  90. NPH : Regular insulin
  91. Humulin 70/30
  92. 70%NPH : 30% regular insulin
  93. Novolin 70/30
  94. 70%NPH : 30% regular insulin
  95. Novolog Mix 70/30
  96. 70% insulin aspart protamine suspension : 30% insulin aspart
  97. Glucose meter
  98. Accu-check Active
  99. Ascensia Breeze
  100. Ascensia Elite
  101. Ascensia Elite XL
  102. Lancet
  103. blood
  104. preferably human and belonging to px
  105. Identify appropriate sites on the body for insulin injection.
  107. repeated injection in same site without rotation can cause lipotrophy, other atrophies and fibrosis
  108. injection sites in decreasing order of absorption
  109. abdomenupper armsthighships
  110. physician argument
  111. some recommend use of all sites in one area before moving therefore stabilizing insulin dose for longest amount of time
  112. others recommend using only abdomen therefore preventing any absorption variances
  113. massaging or exercising injection area can increase rate of absorption and affect px glycemic control
  114. Discuss proper handling and storage of insulin. Demonstrate the proper technique for withdrawing regular and NPH into the same syringe.
  115. gently roll, not shake, insulin while in vial
  116. this also allows warming of insulin for injection
  117. suspensions are susceptible to protein damage with shaking
  118. only suspensions need to be rolled
  119. i.e only the cloudy ones
  120. all insulin preps should be refrigeratedinsulin heat labile protein
  121. 36-46 degrees F
  122. px should constantly inspect insulin prep for discoloration or any other visual changes
  123. when traveling store insulin in cooler with ice or some other cold substance, packing in many layers of clothes can also be used
  124. NPH is longer acting than the faster acting regular insulin
  125. draw the regular insulin first and then draw NPH
  126. regular is clear solution, NPH is cloudy suspension
  127. any addition of NPH into Regular insulin vial will contaminate and potentially affect the absorption and duration of the regular insulin
  128. Regular injection into NPH vial will only cause minor change which is acceptable under most conditions+
  129. When mixing remember to draw an equal amount of air into syringe to account for both volumes of insulin
  130. e.g. 5 U regular and 3 U NPH draw 8 U air
  131. would then inject 5 U air into Regular vial and draw out 5 U regular insulin
  132. would then inject 3 U air into NPH vial and withdraw 3 U NPH
  133. when making this draw can only inject air if bottle bottom is pointed towards ceiling otherwise will inject regular into NPH
  134. Demonstrate proper technique for administering a subcutaneous injection.
  135. sit downpinch up fold of stomach skinpush needle into fold and inject the fold allows easier access to subcu
  136. Identify different insulin administration devices, and counsel on their use.
  137. question 3-1
  138. Discern the effects of concurrent medications on blood glucose control in a diabetic patient.

Exercises

  1. Test your blood glucose value using at least two different meters available. Make sure you have completely read the instructions for your particular meter, and are prepared for the procedure prior to collecting a sample.
  2. Use universal precautions and proper disposal procedures when testing your blood glucose value and practicing subcutaneous injections.
  3. Practice drawing up insulin into a syringe.
  4. Review the case study provided, and determine any potential drug interactions with the patient’s diabetes treatment.
  5. Administer a subcutaneous injection of 0.9% sodium chloride to yourself.

Nonprescription: Diabetes Lecture

Learning objectives:

  1. Describe the prevalence of diabetes (diagnosed and undiagnosed) in the United States.
  2. Recognize specific populations that have a higher prevalence of diabetes and why.
  3. Describe how diabetes affects major physiologic systems and why these particular systems are affected.
  4. Describe symptoms of diabetes and why diabetes causes these symptoms.
  5. Know a “normal” blood glucose range.
  6. Differentiate between Type 1, Type 2 diabetes, and prediabetes.
  7. Describe the current goals and guidelines of therapy for effective management of diabetes.
  8. Describe the risk factors associated with the development of Type 2 diabetes.
  9. Define HbA1C and understand its role in diabetes monitoring. Explain why blood glucose tests are more sensitive than urine glucose tests.
  10. Differentiate between hyperglycemia and hypoglycemia.
  11. Describe symptoms of hypoglycemia.
  12. Recommend appropriate prevention and treatment of hypoglycemia.
  13. Describe the use of oral agents used in the treatment of diabetes.
  14. Compare the types of insulin used in the treatment of diabetes in terms of onset and duration of action, and place in therapy

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