Glucometer Blood Testing

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About this medical skill
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00:00Glucometer Calibration & Testing
00:54Finger Stick Blood Sample Acquisition
Self-assessment

Test your own blood glucose with the meter and verify that you can perform all of the steps

Practice the scenario with the Glucometer Lab Sheet until familiar with the workflow

Try taking this quiz to see if you can differentiate between symptoms of hyperglycemia and hypoglycemia
Equipment and materials
EMS Jump Bag
Glucometer and test strips
Prehospital PPE
Oral Glucose
More video data

Glucometer Blood Testing is included in this California-based EMT program as it is required for skills verification for California Registration. It is not required for National NREMT registration.

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]

  1. After washing your hands, don gloves and insert the appropriate test strip into the meter.
  2. Clean patient's finger with alcohol wipe and let dry.
  3. 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)
  4. Dispose of the lancet in an appropriate sharps container if the blade is not self retracting.
  5. 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.
  6. 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 +
  • Seizures
  • Unconscious to comatose
  • Oxygen and ventilatory support
  • Oral glucose if possible. Patient must have a gag reflex to administer oral glucose.
  • Rapid transport
40-80 Hypoglycemia Rapid onset of:
  • Weak, Rapid pulse
  • Cold, Clammy skin
  • Irritability, Nervousness and Trembling
  • Altered level of consciousness: Confusion, Combative or Psychotic behavior
  • Oxygen
  • Oral glucose
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:
  • Altered Level of Consciousness (ALOC)
  • Warm dry skin, Dry mucous membranes
  • Tachycardia (thready pulse)
  • Deep and labored breathing (Kussmaul respirations)
  • Diuresis/Urinating excessively (Polyuria)
  • Intense thirst and drinking (Polydipsia)
  • Orthostatic hypotension
  • Abdominal pain, Nausea/Vomiting
  • Oxygen
  • Transport
>400 Hyperglycemic crisis
  • Diabetic Ketoacidosis,
  • Hyper osmolar hyperglycemic nonketotic syndrome (HHNS) or
  • Symptomatic hyperglycemia
All hyperglycemia symptoms +
  • Acidosis
  • Acetone ("fruity") breath odor
  • Unconscious to comatose
  • Oxygen
  • Rapid Transport
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EMT +, emergency medical technician +  and paramedic +
hands +  and upper extremities +
diabetes +, high blood sugar +, hyperglycemic +, hypoglycemic +  and low blood sugar +
Glucometer Blood Testing +
Skill +
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