Glucometer Blood Testing is included in this California-based EMT program as it is required for skills verification for California Registration.[1]
Diabetes is a disease of insulin regulation which can result in emergencies from both high blood sugar (hyperglycemia) and low blood sugar (hypoglycemia), which can commonly present with an Altered Level of Consciousness (ALOC). Recognizing and treating blood sugar emergencies in the field or providing rapid transport to definitive treatment is critical. As hyper- and hypoglycemia can sometimes present with similar symptoms, testing a patient's blood glucose with a glucose meter, also called a "glucometer" is an essential prehospital EMT skill.
There are many different types of glucometers. The one discussed on this page is currently being used in the Santa Clara County EMS system. Although the function is similar between most meters, you should be familiar with the one being used in your system, as well as prepared to use an unfamiliar meter provided by a patient or patient's family member.
Calibration. Every meter requires calibration to maintain accuracy. Some use a special coded test strip to calibrate the meter to read test strips from that same lot accurately, other types include the calibration information with each test strip, or maintain sensitivity from lot to lot on the test strips so that no re-calibration between test strip lots is required. All meters are slightly different, so always refer to your user's manual for specific instructions, and ensure that if you are using the correct test strips for the meter and that it is calibrated to the lot number of the strips you are using (if applicable). Strips are not interchangeable between different meter manufacturers.
How to use a calibrated blood glucose meter[edit | edit source]
- After washing your hands, don gloves and insert the appropriate test strip into the meter.
- Clean patient's finger with alcohol wipe and let dry.
- Use a sterile lancing device (lancet) on the side of the patient's fingertip to puncture the skin and express a drop of blood large enough to fully wet the collection well (if access is difficult on the finger, alternate sites can be forearm, thigh, fleshy part of the hand or undiluted blood from an IV line if present)
- Dispose of the lancet in an appropriate sharps container if the blade is not self retracting.
- Touch and hold the edge or the well of the test strip to the drop of blood and ensure that it wicks fully into the collection chamber of the test strip.
- Within a few seconds, the blood glucose level will appear on the meter's display in mg/dL (milligrams of glucose per deciliter of blood).
Ranges and Treatment[edit | edit source]
In normal circumstances, a person's blood glucose varies with time of day as well as their level of exercise, and consumption of food. Normal ranges are fairly narrow, but physical symptoms of hyper- and hypo-glycemia can often overlap:
| Range | Patient's likely condition | Symptoms | Treatment |
|---|---|---|---|
| <40 | Hypoglycemic crisis | All hypoglycemia symptoms +
|
|
| 40-80 | Hypoglycemia | Rapid onset of:
|
|
| 80-120 | Normal blood glucose before a meal
(preprandial plasma glucose) |
none | |
| <180 | Normal blood glucose 1-2 hours after beginning of the meal
(postprandial plasma glucose) |
none | |
| 180-400 | Hyperglycemia | Gradual onset of:
|
|
| >400 | Hyperglycemic crisis
|
All hyperglycemia symptoms +
|
|
Documentation[edit | edit source]
Documentation of blood glucose should be included in the Patient Care Report (PCR) in the form:
- "Arrived to find patient lying supine on couch in presence of wife. Patient is semi-conscious, delayed tracking of EMS upon approach. Patient has pale, clammy skin signs; patient does not exhibit respiratory distress. Patient is a 58 yo Male who took his insulin with the intent of eating lunch but was called away before he could eat. Patient's wife found patient lying on couch and called 911. Patient has history of diabetes and is compliant with all medications. Patient BSL 43 mg/dL. Patient has intact gag reflex and is able to self-administer oral glucose. Patient mental status improves, skin regains color; repeat BSL 106 mg/dL."
Self Assessment[edit | edit source]
- Test your own blood glucose with the meter and verify that you can perform all of the steps
- Practice the scenario with the Glucometer skill Sheet until familiar with the workflow
- Try taking this quiz to see if you can differentiate between symptoms of hyperglycemia and hypoglycemia
- Test your knowledge with this quiz
Tips and Tricks[edit | edit source]
- Type I diabetes is an autoimmune condition where the body's immune system attacks the beta cells of the pancreas. This prevents the patient from producing insulin (which moves glucose from the blood to the cells) and "starves" the cells of glucose. These patients must take insulin to maintain homeostasis. Patients with Type I diabetes may be found hypoglycemic after taking insulin and not eating soon enough or hyperglycemic if they have not taken their prescribed insulin recently.
- Type II diabetes is often seen later in life, though the obesity epidemic and increased sedentary lifestyle has lead to an increase in teen and childhood diagnoses. In this condition, the patient's body becomes resistant to the effects of insulin.
- Not all patients with elevated blood glucose are symptomatic. Patients with Type II diabetes (insulin resistant diabetes) may be found asymptomatic with much higher blood glucose levels than those with Type I diabetes (autoimmune). This is because Type II diabetics still possess a way to facilitate glucose movement into the intracellular space.
- Patients with diabetes may have compromised peripheral vasculature during later stages of the disease. A glucometer uses capillary blood glucose, so alternative sites of capillary blood such as the earlobe and palm may be used if the patient has poor peripheral circulation or thick skin.
- Glucometers used in the prehospital setting will generally only read to 600 mg/dL. Past this value, a "HI" value is shown. In the hospital environment, the blood is able to be diluted to determine true serum glucose level. In the prehospital environment, any patient with a BSL "HI" should be transported if possible for insulin therapy.
Additional Resources[edit | edit source]
TBD - extra videos to watch, links to other pages for more reading