Download Self Monitoring of blood glucose - Diabetic patients in care homes

CARE HOME ISSUE 5
NOVEMBER 2014
Medicines Management Team
Self Monitoring of blood glucose Diabetic patients in care homes
Cambridgeshire and Peterborough CCG Medicines
Management Team have been providing a pharmacist led
medication review service for care home residents since
April 2013.
This newsletter is designed to support Care Homes and
GP’s with blood glucose monitoring for diabetic residents in
care homes.
Highlights:

Self monitoring of blood
glucose is recommended
as part of an integrated
care package,
accompanied by
education.

The patients treatment
regime, lifestyle and
individual needs should
be taken into account to
determine if self blood
glucose testing is
clinically appropriate and
how frequently the person
with diabetes needs to
test.

Patients that are self
monitoring their blood
glucose should have the
use of their blood glucose
monitor assessed at least
annually.
This newsletter provides guidance on self monitoring of
blood glucose following NICE recommendations, suggested
blood glucose levels, signs and symptoms of
Hypoglycaemia (Hypos) and the use of lancets.
Inside this issue:
Self monitoring of blood glucose
Pg. 2
Target blood glucose levels
Pg. 3
Long term blood glucose control
Pg. 3
Hypoglycaemia - Signs and Symptoms
Pg. 3
Key points when testing blood glucose
and the use of blood glucose monitoring
equipment
Pg. 4
Circulation to all GP practices FAO all clinicians, Community Pharmacies, Hospital and CCG clinical staff and Care Homes
For further information and references, please contact Medicines Management Team, Cambridgeshire and Peterborough CCG
Tel: 01480 387 125 Email: [email protected]
Medicines Management Team
CARE HOME ISSUE 5
Self monitoring of blood
glucose
Page 2
Self monitoring of blood glucose is only recommended for certain diabetic individuals on specific
medication regimes. It is recognised that in the care home setting, nurses and carers may be involved in
the ‘self’ testing of blood glucose on behalf of some patients.
Monitoring of blood glucose is recommended as part of an integrated care
package, accompanied by education, which includes self monitoring of blood
glucose levels that enables the individual or carer to interpret results and use the
data to reinforce lifestyle change, or inform their healthcare professional. The
patients’ treatment regimen, lifestyle and individual needs should be taken into
account to determine if blood glucose testing is appropriate and how frequently
the person with diabetes needs to test. Although there are recognised benefits to blood glucose testing to
inform decisions around therapy and monitor for signs of hypoglycaemia, blood glucose testing has the
potential to cause patient anxiety and pain at the sight of finger pricking.
NICE guidelines recommend self monitoring of
blood glucose:
NICE guidelines recommend that:
Patients that are self monitoring blood glucose
 to those on insulin treatment
should be assessed at least annually and in a
 to those on oral glucose-lowering medications structured way to check:
where there is a risk of hypoglycaemia
 to assess changes in glucose control resulting 

from medications and lifestyle changes
 to monitor changes during periods of acute 

illness
 to ensure safety during activities, including 

driving
Note: patients who are stable and ‘diet’
controlled diabetics would not routinely self
monitor their blood glucose levels unless
advised by a health professional, or if any of
the above points apply.
self-monitoring skills
the quality and appropriate frequency of testing
the use made of the results obtained
the impact on quality of life
the continued benefit
the equipment used.
Where self monitoring is considered clinically
necessary but a resident does not have the
dexterity to undertake this themselves this role is
often undertaken by care staff.
Not all oral anti-diabetic medication commonly cause hypoglycaemia.
Patients on oral anti-diabetic therapy will be advised by their health professional if it is appropriate to self
monitor their blood glucose. Normally this applies to patients on specific groups of medication including
those on sulphonylureas, which include the medication gliclazide. Patients on diet control ONLY or taking
the anti-diabetic drug, Metformin as the only diabetic treatment, do NOT need glucose monitoring. They
will only need once or twice a year monitoring of HbA1c. Advice should be sought from a GP or diabetic
nurse at the practice as to whether it is appropriate to test blood glucose for patients on oral therapies
and how often and when this should be done. Note that increased frequency of testing may be needed,
for example, during periods of illness or where medication adjustments are being made.
Recommendations are based on individual patients needs.
Remember that it is only appropriate to test blood glucose if the results are interpreted
and used by health professionals to make informed decisions on medication or
lifestyle adjustments.
For further information and references, please contact Medicines Management Team, Cambridgeshire and Peterborough CCG
Tel: 01480 387 125 Email: [email protected]
Medicines Management Team
CARE HOME ISSUE 5
Target blood glucose
levels
Page 3
It is important that patients and carers are aware of the frequency of blood glucose testing and when this
should be conducted. Normally a pre-prandial level (before meals) and a post prandial (2 hours after
meals) level is taken.
NICE recommended target blood glucose level ranges
Target Levels by Type
Before meals
(pre prandial)
2 hours after meals
(post prandial)
Non-diabetic
4.0 to 5.9 mmol/L
under 7.8 mmol/L
Type 2 diabetes
4 to 7 mmol/L
under 8.5 mmol/L
Type 1 diabetes
4 to 7 mmol/L
under 9 mmol/L
Children w/ type 1 diabetes
4 to 8 mmol/L
under 10 mmol/L
NB: There are
differing opinions
about the ideal
blood glucose
level range.
Individual needs should be discussed with the healthcare team. It is advised that within the care plan
of residents with diabetes, details of the frequency of self blood
glucose testing is documented on an individual basis and details
of the circumstances or blood glucose levels when medical
advise should be sought.
Hypoglycaemia or hypo occurs at
blood glucose levels of less than
Nutritional assessment and diet should form part of individual 4mmols/L. Older people may have
care plans in care homes. Personal food preferences are added risk factors which can lead to a
important in any diet plan and older people with diabetes should hypo:
 being prescribed five or more
be able to continue to enjoy a wide variety of foods.
medications
In some cases dietary advice for the older person with diabetes  chronic kidney problems
may differ from general recommendations. Older people in care  poor food intake
homes are often more likely to be underweight than overweight.  having other illnesses or conditions
It may not always be appropriate to reduce the fat, salt and
sugar for every older person with diabetes. Poor or irregular Many older people find their hypo
warning symptoms become less
eating can often be a cause of hypoglycaemia.
obvious, and some have no symptoms
at all. This may mean that the first
Long-term blood glucose control review
signs noticed by a carer are:
 inability to concentrate
At the regular diabetic review, patients should have their HbA1c  unexplained confusion
level checked to give a better picture of longer term blood  morning headaches
glucose control (blood glucose levels over the past 2-3 months).  sleep disturbance
 sweating
NICE guidelines recommend measuring the individual's
HbA1c levels at:
Residential settings providing care for
Hypos


2–6-monthly intervals (tailored to individual needs) until people with diabetes should have a
diabetes
policy
which
includes
the blood glucose level is stable on unchanging therapy
management and prevention of hypos,
6-monthly intervals once the blood glucose level and blood
diabetes care plans for individuals and
glucose-lowering therapy are stable
diabetes skills training for staff.
Overall aim is to avoid ketoacidosis (Glucose >20) or hypoglycaemia (Glucose <4) which might
lead to avoidable hospital admissions.
For further information and references, please contact Medicines Management Team, Cambridgeshire and Peterborough CCG
Tel: 01480 387 125 Email: [email protected]
Medicines Management Team
CARE HOME ISSUE 5
Key Points
Page 4
Key points for Care home staff to consider when testing blood glucose:
Has blood glucose testing been recommended by the residents GP or diabetic nurse? Remember
not all patients who are diet controlled diabetics or on some oral anti-diabetic medication require
regular monitoring of blood glucose.

Patients on insulin therapy or those that drive will have been given specific recommendations via
their diabetic nurse on self- monitoring of blood glucose.
Ensure blood glucose test strips are

Is the patient on a stable medication regime? More frequent
only ordered when required, e.g. if
monitoring may be required until this is stable as advised by
weekly monitoring is recommended
the GP or diabetic nurse.
then a single box of 50 test strips

If the patient is unwell or diet or activity levels have changed,
will almost meet this requirement
more frequent monitoring may be required until this is stable
(depending on product expiry date)
as advised by the GP or diabetic nurse.

To prevent hypos, it is helpful to have regular mealtimes and snacks containing carbohydrate
available. Carers need to be aware of the symptoms of a hypo and what to look out for in individuals
who may be at risk.

Blood glucose level monitoring is only appropriate if the results are interpreted and is used to inform
health professionals of changes to treatment or lifestyle at agreed time intervals.

On going need for self monitoring of blood glucose should be reviewed periodically, ideally at the
annual diabetic review.
Blood glucose monitoring can help to identify older people who may be at risk of hypos but must
always be looked at together with longer term blood results like HbA1c to give a clearer picture of
control.

Key points to consider when using blood glucose monitoring equipment:




Lancets are for single use only, and should be disposed of via a sharps bin.
Lancets are available in different sizes; the higher the gauge, the smaller the
diameter of the needle. A higher gauge needle is generally less painful but
may not provide sufficient blood for testing.
Always use the sides of the finger rather than the sensitive tip to reduce pain
associated with blood glucose testing.
Test strips differ in where the blood should be placed, please refer to the
leaflet enclosed with the test strips.
Please make sure you know where to apply the blood sample on the test strip


The residents GP will agree which test strip or lancet is most appropriate for them.
Cambridgeshire and Peterborough CCG have published a guide on Choices of Blood Glucose
Meters and Test Strips:
http://www.cambsphn.nhs.uk/Libraries/Newer_drugs_for_diabetes/
BGTS_recommendations_v4_September_2013.sflb.ashx
There is also a document which provides information on diabetic needles for insulin pen
administration and the cost effective choices:
http://www.cambsphn.nhs.uk/Libraries/Newer_drugs_for_diabetes/
Cost_effective_needle_choices_May_2014_version_2.sflb.ashx
For further information and references, please contact Medicines Management Team, Cambridgeshire and Peterborough CCG
Tel: 01480 387 125 Email: [email protected]