Hailey Tran
Blood glucose monitoring is essential for people with diabetes to manage their condition and prevent serious health complications. The frequency of glucose level checks depends on various factors, including the type of diabetes, overall health, and daily lifestyle demands. Hospitals employ different methods for monitoring glucose levels, such as capillary blood glucose (CBG) tests and plasma glucose venous blood tests. Continuous glucose monitors (CGMs) are also available for round-the-clock glucose measurements, providing a detailed picture of glucose fluctuations. Inpatient hyperglycemia is defined as glucose levels exceeding 140 mg/dL, while hypoglycemia is categorized into levels based on severity, with level 3 requiring immediate attention. The American Diabetes Association recommends standardized treatment protocols for hypoglycemia and emphasizes the importance of individualized care plans.
| Characteristics | Values |
|---|---|
| How often to check glucose levels in a hospital | Depends on the type of diabetes and other factors like diabetes medicines, overall health, and daily life demands. |
| Methods to check glucose levels in a hospital | Glucose meter, continuous glucose monitor (CGM), capillary blood glucose (CBG) tests, and plasma glucose venous blood tests. |
| Target glucose levels | The American Diabetes Association suggests the following targets for most non-pregnant adults with diabetes: A1C: Less than 7%; A1C may also be reported as eAG: Less than 154 mg/dL; Before a meal (preprandial plasma glucose): 80–130 mg/dL. |
| Hyperglycemia in hospitalized patients | Defined as blood glucose levels >140 mg/dL (7.8 mmol/L). |
| Hypoglycemia in hospitalized patients | Level 1: Glucose concentration <70 mg/dL (3.9 mmol/L) but ≥54 mg/dL (3.0 mmol/L); Level 2: Glucose concentration <54 mg/dL (3.0 mmol/L), requiring immediate action; Level 3: Severe event with altered mental and/or physical functioning, requiring assistance for recovery. |
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What You'll Learn
Continuous Glucose Monitors (CGMs)
CGMs use a tiny sensor that is inserted under the skin to measure glucose levels in the fluids between the body's cells (interstitial fluid). There are several types of CGMs, including “real-time” CGM devices, which send and display information to a smartphone or receiver automatically, and "intermittent-scan" CGMs, which must be scanned with a separate receiver or smartphone every few hours to view and store data. Some CGMs also link directly to specific insulin pumps.
CGMs offer several benefits over traditional finger stick checks. They reduce the number of finger stick checks needed, provide more information about blood sugar trends, and can help prevent potentially life-threatening complications from hypo and hyperglycemia. Additionally, CGMs are water-resistant and can be worn for several days at a time. They can also be linked to apps that allow users to set alarms and notifications for when their glucose levels are out of their individual range.
Despite these advantages, CGMs do have some limitations. They can be expensive and may not be covered by insurance. Additionally, like all technology, CGMs can sometimes fail or be inaccurate, so it is important to continue with occasional finger stick checks to ensure accurate readings.
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Finger stick checks
When performing a finger stick check, it is important to use the side of the finger where there are fewer nerve endings to reduce pain. It is also recommended to use the client's non-dominant hand to further reduce discomfort. To avoid contamination and ensure accurate results, it is important to rotate puncture sites if testing frequently and to wipe away the first drop of blood that emerges. Control testing should be completed every 24 hours to ensure the glucometer is functioning properly, and it is important to check the expiration dates on test strips and control solutions.
While finger stick checks are widely used, it is important to be aware of their limitations. The International Organization for Standardization (ISO) has issued guidelines suggesting that for glucose levels below 75 mg/dl, a meter reading should be within 15 mg/dl of the reference sample, and for levels above 75 mg/dl, the reading should be within 20%. However, even with these guidelines, there can still be a significant degree of imprecision in the results. Therefore, it is important for patients and healthcare providers to understand the limitations of finger stick checks and to interpret the results accordingly.
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Diabetes care plans
Diabetes is a chronic disease characterised by insufficient insulin production in the pancreas or when the body cannot efficiently use the insulin it produces. This leads to an increased concentration of glucose in the bloodstream, a condition known as hyperglycemia.
Monitoring Blood Glucose Levels
Monitoring blood glucose levels is crucial for managing diabetes. Patients can use a glucose meter and finger stick method or a continuous glucose monitor (CGM) for this purpose. The frequency of checks depends on factors such as the type of diabetes, overall health, and daily demands. Healthcare providers will advise patients on the suitable monitoring method and frequency. Patients may need to check their blood sugar levels several times a day, especially if they are taking insulin or are pregnant. CGM devices provide continuous glucose measurements and can alert patients to high or low glucose levels. However, they should be used alongside finger stick checks for confirmation.
Lifestyle Choices
Lifestyle choices significantly impact diabetes control. Patients should be educated about the effects of diet, exercise, stress, and medications on their glucose levels. They should be encouraged to adhere to a prescribed treatment program, which may include a balanced diet, exercise, and medication. Alcohol consumption should be moderate, as it can affect blood sugar levels. Smoking cessation is also recommended, as smoking increases the risk of developing various diabetic complications.
Dental Care
Diabetes patients are at an increased risk of severe gum infections. Therefore, they should be advised to maintain good oral hygiene by brushing and flossing their teeth at least twice daily and undergoing regular dental exams.
Medical Follow-ups
Patients should be encouraged to attend follow-up appointments with specialists, particularly those managing their diabetes, such as endocrinologists. This ensures ongoing assessment and adjustment of their treatment plans.
Stress Management
Long-term stress can interfere with insulin function and lead to increased glucose levels. Patients should be guided on appropriate stress management techniques to avoid this issue.
Education
Education is critical in diabetes care. Patients who understand their condition and its management can make informed choices. Referrals to diabetes nurse educators or diabetes education programs can provide patients with the knowledge and skills needed to manage their diabetes effectively.
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Blood glucose targets
For individuals with type 1 diabetes, the goal is to replace insulin in the right amount and at the right time. To minimize the risk of hypoglycemia, providers often recommend targeting a pre-meal blood glucose level of 80–130 mg/dL (or 90-130 mg/dL, according to some sources) and a post-meal level of less than 180 mg/dL. These targets may vary depending on individual circumstances, such as pregnancy or hypoglycemia unawareness.
For those with type 2 diabetes, the glycemic targets may be more or less stringent depending on the patient's condition. The American Diabetes Association recommends blood glucose levels that correlate with achieving an A1C of <7% (53 mmol/mol) for many non-pregnant adults. However, A1C testing may not always be the sole basis for assessing glycemic control, and CGM devices can provide continuous glucose data for a more comprehensive understanding of glucose levels.
It is important to note that blood glucose targets should be individualized, taking into account factors such as the type of diabetes, age, overall health, daily demands, and diabetes medications. Healthcare providers will give specific recommendations based on these factors, and regular blood sugar monitoring is crucial to achieving and maintaining these targets.
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Treatment for hypoglycaemia
Blood glucose level monitoring is crucial to identify fluctuations in blood glucose levels that occur in response to diet, exercise, medications, and pathological processes. Unusually high or low blood glucose levels can lead to acute or chronic life-threatening conditions.
The treatment for hypoglycaemia aims to restore normal blood glucose levels as soon as possible. The specific treatment depends on the severity of hypoglycaemia, whether intravenous (IV) access is available, and if the patient can consume food or drink. Here are some common treatments:
- Glucagon Administration: Glucagon is a hormone that stimulates the liver to release stored glucose, raising blood glucose levels. It is the first-line treatment for severe hypoglycaemia in individuals who are unconscious or unable to take oral carbohydrates. It can be administered intramuscularly, intravenously, subcutaneously, or intranasally. Intranasal glucagon is absorbed through the nasal mucosa, and its dose does not need to be inhaled. It is effective in treating hypoglycaemia in both adults and children.
- Intravenous Dextrose: Intravenous dextrose solutions, such as D50 injections, are commonly used to treat hypoglycaemia, especially in patients on insulin therapy. Higher dextrose concentrations are more irritating to the veins, while lower concentrations (10-15%) are less irritating but may require larger volumes and may not be suitable for all patients.
- Glucose Drip: In some cases, a glucose drip may be used to maintain normal blood glucose levels until the patient can receive stable nutrition. This is particularly important when the cause of hypoglycaemia is not insulin-related.
- Dietary Adjustments: Medically ordered dietary restrictions, adjustments to different foods, and reduced calorie consumption during hospitalisation can impact carbohydrate and calorie intake, affecting blood glucose levels. Timing the administration of short-acting insulin relative to food intake is crucial to prevent hypoglycaemia. Ideally, short-acting insulin should be given 10 to 15 minutes before a meal.
- Hospital Protocols: Hospitals should have standardised hypoglycaemia management protocols to ensure prompt and evidence-based care for patients at risk of hypoglycaemia. These protocols should be developed by an interdisciplinary team, including physicians, nurses, pharmacists, and diabetes educators.
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Frequently asked questions
The frequency of glucose level checks in a hospital setting depends on the patient's condition and specific needs. For diabetic patients, glucose levels may be monitored several times a day using finger stick checks or continuous glucose monitors (CGMs). CGMs provide constant monitoring and can send alerts when glucose levels are too high or low.
Normal glucose levels in a hospital setting are typically defined as being within a target range, which can vary depending on factors such as age, health, and whether the patient has diabetes. For non-pregnant adults with diabetes, the American Diabetes Association suggests a target A1C of less than 7%.
If glucose levels are too high or low in a hospital setting, healthcare providers will take immediate action to address the issue. For hypoglycaemia (low blood glucose), this may include administering glucose or adjusting the patient's diabetes treatment plan. For hyperglycaemia (high blood glucose), alterations in diet or changes to certain medications may be recommended.
