Capillary Blood Glucose Monitoring or CBG monitoring as it is commonly

called plays an important role in achieving levels of diabetes control which are
associated with reduction in the risk of developing diabetes complications.
With CBG results to base on, treatment may be adjusted in order to better
achieve the recommended blood glucose targets, such as in cases wherein
diabetes is controlled by either oral medication or insulin injection for a very
stable patient.
CBG monitoring may be done every 4 hours, 2 hours, etc or sometimes 2
hours before or after a meal depending on the physicians preference and
order. This is called Pattern Monitoring and can be helpful to make sure the
best treatment is chosen and is working.
Usually, this test is indicated for patients who:
controls their diabetes with insulin (with or without other
agents)

are poorly controlled and are being considered for insulin

treatment

are treated with Gliclazide, glimepiride, Glipizide, Tolbutamide,

Glibenclamide, Repaglinide and Nateglinide since they can be at
an increased risk of hypoglycaemia (blood glucose below 4
mmol/l).

are treated with Exenatide plus Gliclazide, Glimepiride,

Glipizide, Tolbutamide and Glibenclamide as they can be at an
increased risk of hypoglycaemia (blood glucose below 4 mmol/l).
For outpatients who have unstable blood sugar levels or during episodes of
infection or other illness, CBG monitoring may be advised.

In shorter words, CBG monitoring allows on-going assessment of diabetic

control.
Nurses Role
Nurses play a key role in both performing regular and accurate CBG
monitoring and in teaching people about its use.
With a glucometer, lancet and CBG strips in hand, we, nurses may be able to
estimate the amount of glucose the patient has in his blood in seconds. The
CBG result will serve as a basis for adjusting treatment and medications. Like
for example, whether it is advisable to give insulin injections to the patient and

on how much (in units) should be given to the patient. Mostly, CBG results are
relayed to the physician assigned or the resident on duty for management.
They may either order to give medications to address the high glucose result
or not. In other cases, sliding scales are provided by the physician and
available to base upon. It is composed of a range of CBG results (such as
130-140 mg/dl) and their corresponding units of insulin (example: 2 units) to
be injected to the patient using an insulin syringe.
One advantage of CBGs over urine tests is that urine tests do not tell when
the glucose is low, but only when it is high, which happens at times to
patients. When this time happens, medications such as Dextrose 50 50 may
be ordered by the ROD.
The role of nurses in CG monitoring is not limited to performing the test and
carrying out orders to address abnormalities alone. They also play a role in
health teaching about how to perform the test at home. Nurses should teach
the importance of regular glucose determination at home amongst diabetic
persons through the use of CBG monitoring, the normal values and how to
address them. Before a meal, the CBG result should be approximately 70 to
130 mg/dl of blood. After a meal, this number should be less than 180 mg/dl.
With CBG, rapid production of results may be obtained, and timely treatment
and the involvement of patients with their own care may be promoted.
It is important that the nurse emphasizes that the equipment used for CBG
monitoring by people with diabetes needs to be properly maintained so that
the results are accurate and reliable. Also for this purpose, the nurse must
teach them aseptic technique while performing the procedure such as
washing hands prior to the procedure and disinfecting the site first before
pricking. If the tests are not performed appropriately with care and attention to
technique, the results can be flawed and dangerous.

Blood Glucose Monitoring

Definition
Blood glucose monitoring is a method of assessing the concentration of
glucose in the blood. Tests are performed rapidly and easily by using a
reagent strip (e.g. Glucostix) where a minute drop of capillary blood is
obtained from the clients digits (finger or toe), earlobe or heel. On the
condition where the patient has all the equipments this test can be performed
at home, office, hospitals, clinics and even when travelling.
Purpose
Blood glucose tests detect blood glucose levels in people with the following
conditions:
1. Diabetes Mellitus (Type 1, Type 2)
2. Gestational diabetes
3. Neonatal hypoglycemia
4. Diabetic Coma
During the test, a portable blood glucose meter (e.g. Glucometer or One
Touch) is used to give numerical data or measurement of a patients serum
glucose level by inserting the blood stained plastic strip. Some meters are
installed with memory application helpful in storing the sequence of test
results obtained for easy evaluation.

Paraphernalia
1. Reagent strips or test strip
2. Clean Gloves
3. Alcohol pads
4. Lancets or lancing device
5. Portable glucose meter
6. Watch (with second hand)
7. Pen and Logbook for documentation
Procedure
1. Identify the patient by asking the patient to state his/her name.
Also check the clients identification band. ( confirm patients
identity using two patient identifiers, based on the hospital
protocol)
2. Explain the procedure to the patient or parents (if patient is a
child) to gain cooperation.
3. Choose the puncture site. For adults and children fingertips and
earlobe can be use. For infants, the tip of the great toe or heel
can be the site of puncture.
4. Wash hands and don clean gloves.
5. If glucometer is used, load the strip into the device beforehand.
6. Swab alcohol pad to the chosen puncture site. Use sterile/clean
gauze to dry it thoroughly. Piecing the skin with a wet skin
(alcohol) allows the chemical to pass through the outer layer of
the skin thus, causing the procedure more painful and
uncomfortable.
7. To collect a blood sample, position the lancet (pricking needle)
at the side of the site. To minimize pain and patients anxiety
pierce the skin sharply and briefly. This technique also increases
blood flow. For better results, some agencies are using a lancing
device (mechanical blood-letting device) wherein the lancets are
simply loaded in the spring of the equipment. (Its like using a
spring-loaded pen, once you click the button the spring releases

the lancet and immediately retracts it after piercing the skin).

However, be sure to load an unused lancet before using to
prevent spread of blood-transmitted diseases.

8.

Dont squeeze the puncture site to prevent diluting the sample

with fluids from tissues.
9. Cover the entire patch of strip with blood.
10. Place gauze over the punctured area and briefly apply pressure
until the bleeding stops. Ask the parents of a child to do this.
11. If using a reagent strip, leave the blood on the strip for 1
minute (60 seconds). And watch the color change on the strip
while comparing it to the standardized color chart of the product
container.
12. If glucometer is used, simply follow the manufacturers
instruction.
13. Apply an adhesive bandage once the bleeding on the puncture
site has stopped.
14. Remove gloves and record the resulting glucose level from the
digital display for glucometer or from the color of reagent strip to
the standardized chart.
Common Errors in Blood Glucose Monitoring
1. Dropping a very small amount of blood
2. Inappropriate timing ( the test is usually performed before
meals and at bedtime, or whenever hypoglycemia or
hyperglycemia occurs)
3. Squeezing the puncture site too hard allowing tissue fluids to
mix with the sample
4. Improper maintenance of glucometers (dust or blood
accumulation on the digital display)