Chsa Local Health Network Additional Chart: Blood Glucose Monitoring (Adult)
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1
2Affix patient identification label in this box
CHSA Local Health Network
UR Number: ..................................................................
ADDITIONAL CHART:
Surname: .......................................................................
BLOOD GLUCOSE MONITORING (Adult)
Given name: ..................................................................
(MR59H)
Second given name: ......................................................
Hospital: ...........................................................
D.O.B: __ __ / __ __ / __ __ __ __ Sex: .......................
Instructions
Blood glucose monitoring instructions
Medical and nursing review instructions
•
Treat all BGLs less than 4mmol/L using the CHSA
Test blood glucose according to frequency
•
Hypoglycaemia Protocol.
instructions.
•
Notify medical practitioner when BGL and/or
•
Place a dot ( • ) in the centre of the box which refers
ketones are in a red zone or two consecutive BGL
to the BGL range and connect dots with a straight
readings are greater than 15mmol/L.
line. Record BGL number in line below the graph.
•
Trigger senior nurse review when BGL and/or
•
The target BGL range is 5 to 10 mmol/L unless
ketones in yellow zone and increase monitoring.
modified on relevant RDR chart.
•
MER if patient is unconscious, unsafe to swallow, or
if BGL remains less than 4mmol/L after 45 mins.
•
Initiate actions according to colour zone.
Blood glucose monitoring frequency instruction
Routine monitoring (QID)
Unstable patient (QID + 0200 hrs)
Stable patient (BD)
Test all patients with diabetes before
Also test at 0200hrs if patient has been
If not at risk of hypoglycaemia, and BGL
meals and at 2100hrs until they have
admitted with hypoglycaemia or had
is between 5-10mmol/L, consider testing
hypoglycaemia during admission.
before breakfast and evening meal
been reviewed by a medical practitioner
Date
Time
> 20
17.6 - 20
15.1 - 17.5
12.6 - 15
10.1 - 12.5
7.6 - 10
4.0 - 7.5
2.5 - 3.9
0 - 2.4
BGL
Ketones
Hypo protocol ()
Dr. Notified ()
Intervention
See overleaf
Instruction for ketone monitoring (for patients on insulin)
Notification Chart
Ketones are a sign of severe insulin deficiency and
pending ketoacidosis.
Blood
No ketones
1. Test ketones:
Urine
Negative
•
Daily if fasting or when a patient is unwell
•
When BGL is >15mmol/L
Blood
0.1 - 1.0 mmol/L
2. Record ketone level as a number in the box above.
Urine
Small
3. Notify the doctor as per Notification Chart opposite.
Blood
> 1.0 mmol/L
Note: for greater accuracy, Blood Ketone Testing is preferred when available
Urine
Moderate/Large
SA Health
Created
May
Page 1 of 2
2014
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