Diabetes: Blood Glucose Monitoring
This Clinical Information Sheet (CIS) has been developed to assist RACF staff, medical practitioners and relevant professionals with monitoring blood glucose levels, and managing hypoglycaemia, hyperglycaemia and sick days for residents with diabetes.
The initial diagnosis, assessment, medications, and multidisciplinary management of diabetes are beyond the scope of this Clinical Information Sheet.
This CIS covers:
This clinical information sheet is a guide only. It should be used with consideration to the:
Resident’s preferences, existing medical care plans, and advance care plan; Health professional’s role, knowledge, preferences and professional experience; Policies and resources available within the RACF; Requirements of local professional registration and regulatory bodies; and Relevant local legislation.
About Diabetes
Diabetes is the most common chronic health problem in elderly Australians, affecting 23% of adults aged over 75.
Most (90%) cases are non-insulin dependent diabetes (NIDDM), also known as Type 2 Diabetes. Type 2 Diabetes has 3major defects: abnormality of pancreatic insulin secretion, failure to suppress hepatic glucose production, and resistance to the action of insulin in target tissues, e.g. muscle. Insulin dependent diabetes (IDM) or Type 1 accounts for 10% of all diabetes and is caused by an immune-mediated insulin deficiency early in life [1] .
Type 2 Diabetes is a major risk factor for morbidity and death due to coronary heart disease, cerebrovascular disease and peripheral vascular disease. Multiple risk factors for macrovascular disease, in addition to diabetes itself, are frequently found in individuals with diabetes. Thus, the risk factors of smoking, hyperlipidaemia and hypertension should be reduced as much as possible.
The use of insulin and sulphonylureas may be more hazardous in older adults with diabetes due to comorbidities and polypharmacy leading to greater risk of drug interactions, reduced nutritional status, depression and increased risk of falling [1]. The incidence of hypoglycaemia has been reported as 52% in elderly diabetics using insulin, and about 1% in adults aged over 75 years on oral hypoglycaemic medication for Type 2 Diabetes [2].
Elderly adults who experience severe hyperglycaemic complications are more likely to be living in a nursing home and have a concurrent diagnosis of dementia [2]. At times residents with diabetes can become sick from causes other than their diabetes (e.g. gastroenteritis, influenza, urinary tract infection). Acute illness or infection may lead to diabetic complications, most specifically an increase in blood glucose levels, requiring increased diabetic medication. Developing a care plan for monitoring BGL and managing diabetes, when the resident is unwell, decreases the risk of symptomatic hyperglycaemia [7].
Goals of care
Goals of management for residents with diabetes are to:
Improve life expectancy and quality of life; Adequately control symptoms e.g. fatigue, altered vision, weight loss; Prevent acute complications (hypo/hyperglycaemia, infections); Prevent long-term complications (particularly AMI, stroke); Treat existing complications; Manage co-morbidities; Prevent medication interactions/side effects, and Maintain comfort.
The GP and RACF staff should discuss the disease process, symptoms to report, management and the resident’s goals for current and future care, with the resident and his or her family/ representatives.
In elderly residents with multiple medical diagnoses, high level of functional dependency and a limited life expectancy, the major diabetes management goal is to prevent hypoglycaemia and avoid symptomatic hyperglycaemia [3, 4].
Management plan
Residents with diabetes should have a management plan developed by the general practitioner with residential care staff, the resident and/or his or her representative, and be reviewed at least annually.
The management plan may include:
Treatment targets; Resident education and lifestyle changes - healthy eating, exercise, not smoking, no excess alcohol, foot care; Use of oral hypoglycaemics and/or insulin if required - for maintenance and acute exacerbations; Monitoring glycaemic control by blood glucose levels and HbA1c; Acute care plans for hypoglycaemia, hyperglycaemia and sick days; Monitoring for complications by clinical examination (eyes, feet, weight, BP and cardiovascular system, renal function, peripheral neuropathy, infections), and tests (lipids, renal function); Management of complications and comorbidities, e.g. depression, dementia; Monitor medication effects and interactions, Referral as needed (dentist, podiatrist, opthalmologist, dietitian, diabetes educator, endocrinologist); and Advance care plan for end-of-life care.
Decisions should be made regarding resuscitation in the event of cardiac arrest, and preferences for end-of-life care. An Advance Care Plan should be developed, and regularly reviewed particularly following an acute event and as part of end stage care. Refer to Clinical Information Sheet on Advance Care Planning for more information.
Provide residents with diabetes and their families with education about diabetes sick days, hypo- and hyperglycaemia, including signs and symptoms to report to staff. Incorporate ongoing education into care planning with any change to the resident’s medications, living arrangements, cognitive status or functional status. [4]
RACF staff who care for residents with diabetes, require access to up-to-date education on the management of diabetes and complications associated with the disease.
Monitoring Blood Glucose Levels
Blood glucose measures are done routinely to assess diabetes control, hypoglycaemia and hyperglycaemia.
The ideal aim of treatment of Type 2 Diabetes is normal blood glucose levels. However in the elderly, the aim is avoid remove symptoms, maintain quality of life and avoid hypoglycemia. Working toward an ideal target level of fasting BGL 4-6mmol/l or HbA1c < 7% is important but any reduction in HbA1c will improve outcomes [5].
Special considerations when monitoring blood glucose levels for elderly people are: [2, 4]
Older adults with diabetes are at an increased risk of developing hypoglycaemia, and are also more susceptible to hypoglycemic unawareness concealing early signs and symptoms of hypoglycaemia development. Hyperglycaemia symptoms in older adults with diabetes may present without excessive thirst and/or urination, be masked by other conditions such as urinary incontinence, or be mistakenly attributed to normal ageing [2].
Residents of RACFs who are diagnosed with diabetes should have PRN orders for care in the event of a diabetic emergency, and of illness not related to diabetes, e.g. colds, minor infections. These should include an indication of frequency of BGL monitoring, alterations to the resident’s medication regime, e.g. PRN insulin and glucagon orders, instructions as to when PRN medication orders should be used, and indications for contacting the resident’s GP. Access to emergency stock of medication is essential. RACFs should have policies in place to ensure appropriate storage of medications and replacement of expired emergency medications. Residents with diabetes should have access to appropriate forms of glucose and carbohydrates at all times. [4]
The resident’s GP should indicate in the resident’s diabetes care plan the frequency and timing of BGL testing. If a resident with diabetes displays any of the signs and symptoms for either hyperglycaemia or hypoglycaemia a BGL test should be performed. Symptoms are discussed in the following sections. It is also appropriate to check the BGL of a resident who has not been diagnosed with diabetes, but who displays signs and symptoms with no other obvious cause.
Registered Nurses Div II and PCWs are responsible for monitoring blood glucose levels, initiating treatment and providing care within their scope of practice under the direction of and reporting to a Registered Nurse Div I or medical practitioner, or in accordance with the RACF’s policies. In-service training sessions can be arranged to familiarise health professionals with the procedure.
Residents who choose to monitor their own BGLs and manage their medications should be assessed as safe to do so. The resident has a responsibility to report his or her signs and symptoms, any emergency medication that has been self-administered and BGL results to RACF staff members and to request assistance when appropriate.
Procedure for monitoring BGL
Equipment
The following equipment is required:
Blood glucose monitoring system (including test strips, lancet device); Cotton Wool ball/tissue; Non-sterile gloves; Sharps container; and Blood glucose monitoring chart
There is a wide range of blood glucose monitoring systems on the market and each model has its own specific method of operation. Before using a particular blood glucose monitoring system for the first time read the instruction manual and become familiar with its operation. Mistakes can occur in blood glucose readings due to instrument or user error [6, 7]. For most blood glucose monitoring system models follow these recommendations:
Check the expiry date on the test strip packet; Ensure that the blood glucose monitoring system is calibrated to the test strip batch by following the instruction manual; Avoid touching the reactive part of the test strip or blood glucose monitoring system sensor; Clean the blood glucose monitoring system regularly according to manufacturer’s instructions; and Repeat BGL testing if an error is suspected [7].
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Procedure for taking a BGL[7, 8]
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1. |
Explain the procedure, answer questions and prepare the resident. |
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2. |
Wash the resident’s hands with warm water and soap. Presence of sugar, lotions and creams on fingers can alter the results. Warm water stimulates blood flow to the fingers. |
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3. |
Wash your hands. Set-up and check the equipment. Put on non-sterile disposable gloves. |
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4. |
Assess the resident’s fingers to select a finger-prick site. Avoid the thumb and forefinger if possible, and select a site without many previous prick wounds. |
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5. |
Massage the finger from palm to fingertip in a gentle ‘milking’ action to promote blood flow to fingertip. |
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6. |
Prick the finger lateral to the nail and repeat milking action only if there is insufficient blood. |
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7. |
Place drop of blood on the reagent strip. |
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8. |
Follow operation guidelines on the blood glucose monitoring system used in the facility. There is a large variety of blood glucose monitoring system, each with specific instructions. |
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9. |
Place cotton ball or tissue on puncture site and ensure resident is comfortable. |
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10. |
Dispose of needle in appropriate sharps disposal container. Dispose of test strip in appropriate infectious waste bin. |
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11. |
Read and record the blood glucose level from the blood glucose monitoring system. |
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12. |
Report results and/or initiate treatment as required. |
Errors can occur in blood glucose monitoring. The most common sources of error include:
Technique, e.g. not washing the resident’s hands; Incorrect storage or handling of the test strips; or Equipment problems, e.g. machine not calibrated to test strip batch.
BGL monitoring should only be performed by qualified health professionals who have been trained in the use of blood glucose monitoring equipment. The instructions for the specific blood glucose monitoring system in use in the RACF should be followed carefully. A daily quality control test should be performed according to the instructions for the specific blood glucose monitoring system in use [9].
Managing Hypoglycaemia
Hypoglycaemia is an acute complication of diabetes that occurs when an individual’s plasma glucose concentration falls to a level where the body does not function normally. Hypoglycaemia is diagnosed when an individual [2, 4, 9]:
Develops signs and symptoms of lowered plasma glucose levels; Has a low blood glucose level; or Has symptoms that respond to administration of carbohydrates.
Hypoglycaemia can occur due to [2, 4, 9]:
Excessive medication (insulin or oral hypoglycaemics) and/or poor medication management and administration; Insufficient intake of carbohydrates, e.g. missing or postponing meals; Increased physical activity without appropriate carbohydrate intake; and Alcohol use.
B-blockers can mask early symptoms and lead to sudden neurological symptoms of Hypoglycaemia. Hypoglycaemia can present with signs of a stroke and should be considered in diabetic patients with neurological signs [1].
Hypoglycaemia can range from mild (symptoms are present but respond promptly to treatment) to severe (unconsciousness). Long term complications from hypoglycaemia include cognitive impairment, fitting and coma. [2, 4, 9]
Signs and symptoms
Older adults with diabetes are at an increased risk of developing hypoglycaemia. Due to an age-related reduction in glucose regulation older adults have an increased risk of developing hypoglycaemia. Older adults are also more susceptible to hypoglycemic unawareness, which is said to occur when the individual with diabetes has no early signs and symptoms of hypoglycaemia developing [2, 4].
Consider hypoglycaemia if a resident is displaying these signs and/or symptoms [4, 9]:
Sweating. Dizziness. Trembling. Pallor. Hunger. Anxiety. Confusion. |
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Difficulty concentrating. Tingling (especially hands, feet or tongue). Tiredness/drowsiness. Slurred speech or difficulty speaking. Unconsciousness. Blood glucose level £
4mmol/L#.
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#The recommended clinical cutoff for diagnosis of hypoglycaemia is a blood glucose level of 4mmol/L or less, however blood glucose level at which signs and symptoms of hypoglycaemia develop is different between individuals [4, 9].
Treatment of Hypoglycaemia [4, 9]
Hypoglycaemia should be confirmed by blood glucose measurement, however treatm,ent is urgent and should not be withheld if undue delay is likely [1].
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Guideline for Treatment of Hypoglycemia [3, 7]
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1. |
Check the resident’s care plan and medication chart to determine if there is a standing order for action to be taken in the event of a low BGL. If the GP has outlined a clinically appropriate plan for the management of the resident’s hypoglycaemia implement that course of action. |
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2. |
Implement these guidelines when the resident’s blood glucose level is £
4mmol/L and there is no documented appropriate management strategy in the resident’s care plan. |
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3. |
Mild and Moderate Hypoglycaemia; symptoms present but able to administer treatment:
i) Administer 15g of carbohydrate, preferably in the form of glucose or sucrose tablets.
ii) Re-test blood glucose level after 15mins
iii) If blood glucose level remains £ 4mmol/L administer a further 15g of glucose. |
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4. |
Severe Hypoglycaemia; resident is unconscious and unable to tolerate oral glucose:
i) If there is no PRN order for glucagon or no medication supplies, call an ambulance
ii) Administer PRN order of glucagon if ordered and available, following the manufacturer’s instructions. The usual dosage of glucagon is 1mg administered subcutaneously or intramuscularly.
iii) Re-test blood glucose level after 15mins.
iv) If blood glucose level remains £4mmol/L administer 15g of glucose orally. If the resident is still unable to tolerate oral glucose, call an ambulance. If ordered and available a further PRN order of glucagon may be administered while waiting for emergency services. |
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5. |
Ensure the resident eats the next scheduled meal or snack. If a meal is > 1 hour away, provide a snack consisting of 15g of complex carbohydrate and a protein source, e.g. dairy drink and sandwich; cheese and biscuits. |
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6. |
Increase frequency of BGL monitoring until stable. Contact the resident’s GP if BGL does not become stable. |
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7. |
Determine the cause of the hypoglycaemic event. If the cause is unknown, related to medication administration or related to another diagnosis, contact the resident’s GP for a comprehensive resident review. |
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8. |
Ensure the resident’s condition is documented in the progress notes and the event is communicated to other care staff according to facility policy. |
For quick reference, these steps have been summarised in Reference Card: Hypoglycaemia Management.
Carbohydrates
Glucose powders and tablets are the preferred form of oral carbohydrate for the management of hypoglycaemia [4, 9]. In adults, 15g of glucose is required to produce an increase in BGL of approximately 2.1mmol/L within 20 minutes. 20g of glucose taken orally will increase BGL by approximately 3.6mmol/L within 45minutes. Fruit juices and milks take longer to increase blood glucose levels than oral glucose. For maximum effect, glucose gels and pastes must be swallowed. These products are slow acting, increasing BGL by <1mmol/L in 20minutes [4].
The following are equivalent to a 15g serve of carbohydrate [4, 9]:
15g glucose in the form of glucose tablets (follow product guide for dosage). 15ml (3 teaspoons) of table sugar dissolved in water. 175ml (3/4 cup) of fruit juice or regular soft drink. 6 Lifesaver lollies. 15ml (1 tablespoon) of honey. 15g glucose paste/gel.
Hyperglycaemia
Hyperglycaemia is a complication of diabetes that occurs when an individual’s blood glucose level rises to an unacceptable level. Excessive hyperglycaemia can lead to the short-term acute conditions diabetic ketoacidosis (DKA – more common in Type 1 diabetes) or hyperosmolar nonketotic coma (more common in type 2 diabetes), both of which are life threatening conditions. In the long term, untreated persistent hyperglycaemia can lead to diabetic retinopathy, renal disease, cardiovascular disease and cerebrovascular disease. [2, 9].
Hyperglycaemia occurs due to [1, 7]:
Insufficient medication and/or poor medication management and administration; Emotional or physical stress or illness; Insufficient physical activity; Excessive carbohydrate intake; and Commencement of other medications (eg cortisone).
Signs and symptoms
Consider the diagnosis of hyperglycaemia if an individual is displaying these signs and/or symptoms:
Excessive urination. Excessive thirst. Dry mouth. Tiredness/ fatigue.
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#The recommended clinical cutoff for diagnosis of hyperglycaemia is a preprandial (before eating) BGL >10mmol/L or a postprandial (after eating) BGL >20mmol/L. BGL at which signs and symptoms of hyperglycaemia develop is different between individuals
- Australian Diabetes Educators Association, Guidelines for the management and care of diabetes in the elderly. 1 ed. 2003, Canberra: ADEA, 9.
- Argyle and Clyde Health Board, Nursing Guidelines: care and management of diabetes in registered nursing homes. 2002, Scotland: National Health Services UK,
-Holmwood, C, ed. Diabetes Management in General Practice. 2001, Diabetes Australia: Australia. quoted in National Prescribing Services Limited, Practice Visit Programs - Management of Type 2 Diabetes. 2002, Adelaide: NPSL.
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Hyperglycaemia is of particular concern for older adults with diabetes as symptoms may present differently to those in a younger person. The reasons for this are:
In normal ageing there may be reduction in thirst and increase in renal glucose tolerance, therefore excessive thirst and/or urination may not occur; Signs and symptoms may be masked by other conditions such as urinary incontinence; and Signs and symptoms may be considered by the resident or carers to be due to normal ageing [2].
Treatment of Hyperglycaemia
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Guideline for Treatment of Hyperglycemia
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1. |
1. Check the resident’s care plan and medication chart to determine if there is a standing order for action to be taken in the event of a high BGL. If the resident’s GP has outlined a clinically appropriate plan # for the management of a resident’s hyperglycaemia then implement this course of action. |
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2. |
Implement these guidelines when the resident is symptomatic, has a BGL > 10mmol/L and there is no documented appropriate management strategy in the resident’s care plan, progress notes or medication chart. |
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3. |
If the resident has a high BGL, is symptomatic and is vomiting or unconscious, call an ambulance. |
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4. |
If the resident is symptomatic, has a BGL >10mmol/L and there is no documented strategy of care in the resident’s care plan or medication chart, contact the resident’s GP or locum GP. |
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5. |
Document any emergency phone orders according to the policy of the RACF. Document the event and the medical practitioner’s instructions in the residents care plan and progress notes. |
>#In elderly residents with multiple medical diagnoses and a limited life expectancy, the goal should be more conservative. The resident’s GP may chose not to initiate treatment for hyperglycaemia unless the resident is symptomatic or has a BGL of 12-15mmol/L or greater. The goal in palliative care is to promote the resident’s comfort and prevent hypoglycaemia
-eTG, Therapeutic Guidelines, in http://www.tg.com.au (accessed March 2004), eTG. 2004,
-Canadian Diabetes Association, 2003 Clinical Practice Guidelines, in http://www.diabetes.ca/cpg2003/chapters.aspx (accessed March 2004), CDA. 2003.
The resident’s GP should document such decisions in the resident’s care plan and/or progress notes and medication chart (if appropriate) and provide a guideline for RACF staff on management of hyperglycaemia for the resident.
Sick day care
During periods of acute illness or infection special attention needs to be paid to diabetes. Major illness, e.g. influenza, and minor illnesses, e.g. colds, nausea/vomiting, mild infections, put stress on the body, which can cause BGLs to rise, even if the resident is not eating. Infection in particular can cause high BGLs, and this might be the first sign that a resident is coming down with an illness [11-13].
It is important during periods of illness that a resident with diabetes medication regime is maintained, as the body is still producing sugars even when oral intake is minimal. During illness there may be an increased need for medication, especially if the resident is taking insulin. It is also important to carefully monitor the amount, type and timing of food and fluids to ensure they are appropriate to the resident’s needs[11-13].
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Sick day care for residents with Insulin Dependent Diabetes Mellitus (IDDM, type 1) [9, 11, 12]
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1. |
Check the resident’s care plan and medication chart to determine if there is a documented management plan for action to be taken in the event of the resident becoming ill. If the resident’s GP has outlined a clinically appropriate plan for the management of the resident’s diabetes during a period of illness follow the GP’s instructions. |
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2. |
Implement these guidelines when a resident becomes unwell from a minor illness that affects the resident’s oral intake or BGL readings. |
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3. |
Check and record the resident’s BGL every 1-2 hours and before meals. |
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4. |
Observe the resident every 1-2 hours for signs of hyperglycaemia and dehydration. |
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5. |
Medication Requirements:
Continue to administer the resident’s normal insulin regime. The resident’s GP should provide a guideline for extra insulin requirements, e.g. using a PRN sliding scale of insulin. This should be recorded in the resident’s medication chart and should be administered according to the GP’s orders. - If there are no PRN insulin orders and the resident has symptomatic hyperglycaemia, contact the resident’s GP or locum GP for instructions.
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6. |
Fluid/Food Requirements:
If the resident’s BGL is < 12-14 mmol/L the resident should have 15g carbohydrate food/drink every 1-2 hours that he or she is awake. If the resident’s BGL is > 12-14 mmol/L the resident should avoid food/drinks containing carbohydrate. Encourage the resident to drink plenty of sugar-free liquids to replace fluid loss (see heading below, Food Choices for Sick Days.)
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7. |
If the resident has nausea and/or vomiting:
Check the medication chart for a p.r.n. order for an anti-nausea agent and administer as ordered by the GP. Commence fluids 1-2 hours after vomiting (See heading above: Fluid/Food requirements). If the resident has persistent vomiting contact the resident’s GP or locum GP for further orders.
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8. |
When to contact the GP:
If the resident has a persistently high BGL (> 15mmol/L) and there are no orders for PRN insulin. If the resident has symptomatic hypoglycaemia. If the resident has persistent vomiting or diarrhoea for over 12 hours and is at risk of dehydration. If the resident is unable to consume any oral fluids and is at risk of dehydration. If the resident becomes unconscious.
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9. |
Ensure the resident’s BGLs are recorded in the resident’s progress notes, along with clear notes on what the resident has had to eat and drink. Communicate the resident’s condition to other RACF staff as per facility policy. |
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Sick day care for residents with Non-Insulin Dependent Diabetes Mellitus (NIDDM; type 2) [9, 13]
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1. |
Check the resident’s care plan and medication chart to determine if there is a documented management plan for action to be taken in the event of the resident becoming ill. If the resident’s GP has outlined a clinically appropriate plan for the management of the resident’s diabetes during a period of illness follow the GP’s instructions. |
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2. |
Implement these guidelines when a resident becomes unwell from a minor illness that affects the resident’s oral intake or BGL readings. |
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3. |
Check and record the resident’s BGL every 2-4 hours. |
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4. |
Observe the resident every 2-4 hours for signs of hyperglycaemia and dehydration.
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5. |
Medication Requirements:
Check the resident’s regular medication orders. If the resident takes medication of the Sulphonylurea class, continue to administer medication as normal. If the resident takes Metformin, consult the resident’s regular GP or locum GP for advice on medication administration. See below for more information on medications.
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6. |
If the resident’s BGL is < 12 mmol/L the resident should have 15g carbohydrate food/drink every 2 hours that he or she is awake. If the resident’s BGL is > 12 mmol/L the resident should avoid food/drinks containing carbohydrate. Encourage the resident to drink plenty of sugar-free liquids to replace fluid loss. If able to eat, the resident should have a small meal or snack and a carbohydrate drink every 2 hours.
(see below for more information on food choices) |
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7. |
If the resident has nausea and/or vomiting:
Check the medication chart for a PRN order for an anti-nausea agent and administer as ordered by the GP. Commence fluids 1-2 hours after vomiting (see heading above - Fluid/food requirements). If the resident has persistent vomiting contact the resident’s GP or locum GP for further orders.
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8. |
When to contact the GP:
If the resident has a persistently high BGL (> 15mmol/L) and has symptoms of hyperglycaemia. If the resident has symptomatic hypoglycaemia If the resident has persistent vomiting or diarrhoea for over 12 hours and is at risk of dehydration. If the resident is unable to consume any oral fluids and is at risk of dehydration. If the resident becomes unconscious.
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9. |
Ensure the resident’s BGLs are recorded in the resident’s progress notes, along with clear notes on what the resident has had to eat and drink. Communicate the resident’s condition to other RACF staff as per facility policy. |
Carbohydrates
The following food and drink choices provide 15 grams of carbohydrate and should be used when the residents BGL is less than 12-14mmol/L [11, 13]:
Table Two: Carbohydrate food and drink choices
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Food Choices
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Drink Choices
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1 slice dry toast 2 plain sweet biscuits (e.g. teddybear, arrowroot) ½ cup sweetened jelly or custard 2-3 scoops icecream ½ cup porridge or 2 weetbix 2/3 cup special K or with milk 1 large Premium or Salada 97% fat free cracker or 2 Ryvita crispbreads 1/3 cup cooked rice 1 average icy-pole on a stick
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1 cup of plain milk. ¾ cup plain milk with 1 tablespoon flavouring, e.g. milo. ½ cup fruit juice. Tea or coffee with 1 tablespoon of sugar. Hot lemon juice with 1 tablespoon of honey. 4 satchets of gastrolyte. ¾ cup non-diet soft drink or cordial. 1 cup canned soup made with water. 1 cup sports drink, e.g. gatorade.
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Non-Carbohydrates
If the sick resident has a high BGL (>12-14mmol/L) s/he needs fluid replacement with non-carbohydrate food and drink choices [11, 12], see Table Two.
Table Two: Non-carbohydrate food choices
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Food Choices
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Drink Choices
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Sources of Information
Where to go for more information
For further information the following services can be contacted:
Diabetes Australia (Victoria)
Diabetes Australia is a not-for-profit organisation involved in the management, detection and prevention of diabetes and providing support for people with diabetes and their carers.
Contact: Customer Service 1300 136 588; Direct Business Calls 9667 1777
Australian Diabetes Educators Association (ACT)
Contact: (02) 6287 4822
References
eTG, Therapeutic Guidelines: Endocrinology, in http://www.tg.com.au (accessed November 2006), eTG. 2004
Australian Diabetes Educators Association, Guidelines for the management and care of diabetes in the elderly. 1 ed. 2003, Canberra: ADEA.
eTG, Therapeutic Guidelines, in http://www.tg.com.au (accessed March 2004), eTG. 2004
Canadian Diabetes Association, 2003 Clinical Practice Guidelines, in http://www.diabetes.ca/cpg2003/chapters.aspx (accessed March 2004), CDA. 2003
Royal Australian College of General Practitioners, (RACGP). Diabetes Management in General Practice. Twelfth Edition ed. 2006/7, Melbourne: RACGP,.
American Diabetes Association, Tests of Glycemia in Diabetes. Diabetes Care, 2004. 27(90001): p. 91S-93.
BDMedical, Diabetes Care, in http://www.bddiabetes.co.uk (accessed March 2004), ltd., BD UK. 2004
French, J, General Principles and Procedures Manual. 2000, Melbourne: Open Training Services, Victoria Unversity of Technology.
Board, Argyle and Clyde Health, Nursing Guidelines: care and management of diabetes in registered nursing homes. 2002, Scotland: National Health Services UK.
Holmwood, C, ed. Diabetes Management in General Practice. 2001, Diabetes Australia: Australia. quoted in National Prescribing Services Limited, Practice Visit Programs - Management of Type 2 Diabetes. 2002, Adelaide: NPSL.
International Diabetes Center, Diabetes - Sick Days, in http://ww.parknicollet.com/Diabetes/aboutus.html accessed April 2004, Minneapolis, Park Nicollet Health Services:. 2004
Bradley, B, Sick Day Guidelines. Diabetes Interview, 2003. May.
Diabetes Australia (Vic), Sick Days for type 2 Diabetes. 2002
National Health And Medical Research Council, (NHMRC), Guidelines for the development and implementation of clinical practice guidelines. 1995, Canberra: AGPS.
Levels of Evidence
The guideline has been developed using the process outlined in Chapter Five of the GP and Residential Aged Care Kit.
This clinical information sheet is adapted from three primary sources published by the Australian Diabetes Educators Association, the Canadian Diabetes Association and the UK National Health Service. The information provided in this clinical information sheet is based on Level I evidence and Level IV evidence from national consensus clinical guidelines. The level of evidence of all references used to compile this clinical information sheet is provided in the table below.
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Reference |
Year |
Level of Evidence |
1. |
eTG, Therapeutic Guidelines: Endocrinology, in http://www.tg.com.au (accessed November 2006), eTG. 2004 |
2006 |
Level IV C evidence |
2. |
Australian Diabetes Educators Association, Guidelines for the management and care of diabetes in the elderly. 1 ed. 2003, Canberra: ADEA. |
2003 |
Level I evidence |
3. |
eTG, Therapeutic Guidelines, in http://www.tg.com.au (accessed March 2004), eTG. 2004 |
2004 |
Level IV C evidence |
4. |
Canadian Diabetes Association, 2003 Clinical Practice Guidelines, in http://www.diabetes.ca/cpg2003/chapters.aspx (accessed March 2004), CDA. 2003 |
2003 |
Level IV C evidence |
5. |
Royal Australian College of General Practitioners, (RACGP). Diabetes Management in General Practice. Twelfth Edition ed. 2006/7, Melbourne: RACGP,. |
2006 |
Level IV C evidence |
6. |
American Diabetes Association, Tests of Glycemia in Diabetes. Diabetes Care, 2004. 27(90001): p. 91S-93. |
2004 |
Level IV C evidence |
7. |
BDMedical, Diabetes Care, in http://www.bddiabetes.co.uk (accessed March 2004), ltd., BD UK. 2004 |
2004 |
Level IV C evidence |
8. |
French, J, General Principles and Procedures Manual. 2000, Melbourne: Open Training Services, Victoria Unversity of Technology. |
2000 |
Level IV C evidence |
9. |
Board, Argyle and Clyde Health, Nursing Guidelines: care and management of diabetes in registered nursing homes. 2002, Scotland: National Health Services UK. |
2002 |
Level IV evidence |
10. |
Holmwood, C, ed. Diabetes Management in General Practice. 2001, Diabetes Australia: Australia. quoted in National Prescribing Services Limited, Practice Visit Programs - Management of Type 2 Diabetes. 2002, Adelaide: NPSL. |
2001 |
Level IV evidence |
11. |
International Diabetes Center, Diabetes - Sick Days, in http://ww.parknicollet.com/Diabetes/aboutus.html accessed April 2004, Minneapolis, Park Nicollet Health Services:. 2004 |
2004 |
Level IV evidence |
12. |
Bradley, B, Sick Day Guidelines. Diabetes Interview, 2003. May. |
2003 |
Level IV evidence |
13. |
Diabetes Australia (Vic), Sick Days for type 2 Diabetes. 2002 |
2002 |
Level IV evidence |
Literature was identified through a standardised search for systematic reviews and clinical guidelines published by relevant health organisations; and ‘clinical guidelines’ and ‘practice guidelines’ in CINAHL & MEDLINE databases and HONcode search engine. Literature was evaluated according to relevance to residential aged care patients, and strength of evidence using the NHMRC (1995) [14] scale for randomised control data and lower levels of evidence when RCT is not available. The scale was adapted by adding a level of evidence (level V) for non-referenced material, e.g. developed in local RACFs. Prescribing information is consistent with the Australian Therapeutic Guidelines, at the time of writing.
Applicability of information
This Clinical Information Sheet has been developed with consideration to legislation and any requirements of or recommendations from professional registration groups or regulating bodies (e.g. NBV, RCNA, ANF) overseeing the residential aged care industry in Victoria, Australia. Readers outside Victoria, Australia are advised to review the material in the context of their local legislation and health system regulations.
This Clinical Information Sheet was developed using the process outlined in Section 5, and is provided under the terms of the disclaimer in Section 1 of the GP and Residential Aged Care Kit.
GP and Residential Aged Care Kit: http://nwmdgp.org.au/pages/after_hours/
For more detailed or up to date information than is provided in this CIS, please refer to cited sources and current literature.
Reference Cards for Diabetes: Blood Glucose Monitoring
The following reference cards are designed to be used in conjunction with the Diabetes: Blood Glucose Monitoring Clinical Information Sheet. Because the evidence base and availability of national guidelines for clinical care and multidisciplinary service delivery is rapidly changing, we strongly recommend that the these Reference Cards be regularly reviewed and revised as with Clinical Information Sheets.
Viewing Reference Cards
To view the reference cards, click on the link and select open with.... The document will open in Microsoft Word (for .doc) or Adobe Acrobat for (.pdf).
Printing Reference Cards
To print the reference card, select follow the steps for viewing a reference card, then select print in either Microsoft Word or Adobe Acrobat.
Downloading Reference Cards
To download the reference cards, click on the link and select save to disk. You will be asked to select a folder in which to save the reference card. To download all the reference cards together, use the link under Downloads and Printing.
Reference Cards:
Hypoglycaemia Management
Hyperglycaemia Management
Diabetes Sick Day Management - IDDM (Type I)
Diabetes Sick Day Management - NIDDM (Type 2)
Downloads and Printing
See note on viewing and printing documents.
To download the Clinical Information Sheet and/or the entire Reference Card package for this CIS, use the buttons below. To download, click on the link and select save to disk. You will be asked to select a folder in which to save the document. To download individual Reference Cards use the links above. Downloads are in printable formats.
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