IPSA- Glucose

Accuracy standard for OTC glucose meters?

95% of readings must be within +/- 15% of the true value (lab measurement)

Accuracy standard for POC glucose meters?

95% of readings must be within +/- 12% of the true value (lab measurement)

What physiological factors can make a false low reading

High hematocrit/polycythemia; oxygen therapy

what physiological factors can make a false high reading

low hematocrite/anemia; Hypoxia/high altitude

What medications can cause interference with test strips and cause errors?

ascorbic acid, acetaminophen, alcohol (if not dried prior to testing)

What are some technical variables to cause false readings/errors

unclean skin, not enough blood, excessively squeezing the finger,

improper storage, outdated or wrong test strips

improperly calibrated

What are some mechanical variables to cause false readings/errors

equipment malfunction, battery failure

What are some environmental variables to cause false readings/errors

temperature, humidity, altitudeHow

How do you troubleshoot errors?

check what the error codes are in the manual, then retest correcting it, if that doesn’t work, to a control test

Who should be screened for glucose?

any age if overwieght and one other risk factor

if 35 years old, regardless or weight or risk factors

When should screening be repeated if results are normal?

in 3 years

When should screening be repeated if results are abnormal?

as soon as possible with doctor

What are the diabetes risk factors

Age >35; Overweight or obese; First-degree relative with diabetes; History of CVD; HTN (>130/80 or on meds for HTN); HDL < 35 mg/dl and/or TG >250 mg/dl; Physical inactivity; High-risk race/ethnicity

What are the blood sugar goals in patients without diabetes?

Fasting: <100 mg/dl

Random glucose (ie. Not fasting): <200 mg/dl

What are the blood sugar goals in patients with diabetes?

Fasting plasma glucose (FPG): 80-130 mg/dl

Postprandial glucose (PPG): < 180 mg/dl

What is considered hypoglycemia in all patients?

< 70 mg/dl

What is the criteria for prediabetes?

fasting glucose of 100-125 mg/dL

What is the criteria for diagnosis of Diabetes?

Fasting glucose: > 126 mg/dl (need two abnormal tests done)

Random glucose (ie. Not fasting): > 200 mg/dl PLUS symptoms (polydipsia, polyuria, polyphagia, unexplained weight loss, fatigue, blurred vision)

What to counsel on for Diet?

ask about current diet, including drinks

discuss portion control (esp with carbs)

discuss balanced meals, low-fat, include fruits and vegetables

avoid sugary drinks

How to counsel on weight loss?

Encourage weight loss to help lower the risk and it also lowers blood sugar

if at a healthy weight, just say that

How to counsel on exercise?

exercise can help lower blood sugars

ask about current regimen, find ways to slowly increase that if their risks are higher

Teaching points for glucometer education:

face it towards patients; have them to a return demonstration to you; discuss proper lancet use; discuss logging glucose levels; understand frequency and timing of tests; understand goals and data; control solution

What are some alternate testing sites?

upper arm, thigh, calf, fleshy parts of hand

When can you use alternate testing sites?

depends on if the meter allows, if glucose is stable

Characteristics of selecting a meter

accuracy, ease of use, cost, measurement range, alternate site testing, memory, dexterity and visual help, languages

Other ways of monitoring blood glucose:

self-monitoring + A1c = more accurate

CGMs