Never Retest Low Serum Glucose; Treat Immediately and Then Prevent Further Episodes



Never Retest Low Serum Glucose; Treat Immediately and Then Prevent Further Episodes


Kathleen A. Williams MSN, RN, CRNP

Sherita Hill Golden MD, MHS



Maintaining euglycemia in the inpatient setting has been shown in multiple studies to decrease morbidity and mortality across multiple types of patient populations. One of the leading barriers to achieving optimal glucose control is the fear of hypoglycemia on the part of both patients as well as care providers. This fear is understandable. Hypoglycemia can cause behavioral changes, seizures, permanent neurological injury, and even death. Prompt and appropriate recognition, treatment, and prevention of hypoglycemia is therefore of critical importance.

Current methods for inpatient glucose monitoring include laboratory analysis of serum, point-of-care testing with portable bedside glucometers, and ongoing commercial investigations of continuous subcutaneous and serum glucose monitoring systems for inpatient use. The most accurate is laboratory analysis of a serum value. However, these values often take considerable time to obtain. Bedside glucometers, when used within the manufacturer’s guidelines, can provide a rapid assessment of the patient’s glycemic control. Appropriate training of staff using and interpreting blood glucose values obtained by bedside monitoring is critical to patient safety. Some conditions that alter the accuracy of glucometer readings may include the following:



  • The skin site may be inadequately prepared.


  • The arterial or venous lines may not be adequately cleared before blood is drawn and placed on the glucometer strip.


  • Conditions of decreased peripheral blood flow may not reflect the true physiological state. Examples of decreased blood flow include severe dehydration, hypotension, shock, and peripheral vascular disease or peripheral vasoconstriction due to vasoactive drugs.


  • Acetaminophen levels greater than 8 mg/dL may produce elevated glucose results


  • At glucose values above 200 mg/dL, low hematocrits (<20%) may cause elevated glucose readings compared with a whole blood reference.


  • At glucose values above 200 mg/dL, high hematocrits may cause reduced glucose value compared with a whole blood reference.


Jul 1, 2016 | Posted by in ANESTHESIA | Comments Off on Never Retest Low Serum Glucose; Treat Immediately and Then Prevent Further Episodes

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