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Capillary Blood Glucose Test

Sri Lanka Journal Of Diabetes Endocrinology And Metabolism 2011; 1: 22-24

Sri Lanka Journal Of Diabetes Endocrinology And Metabolism 2011; 1: 22-24

22 Sri Lanka Journal of Diabetes Endocrinology and Metabolism How reliable are capillary blood glucose measurements? H N Rajaratnam1 , S Pathmanathan2 1Consultant Physician and Endocrinologist, Nawaloka Hospitals Limited,Colombo 2, 2Senior Registrar in Endocrinology, National Hospital of Sri Lanka. Capillary blood tests measure whole blood glucose as opposed to venous samples which measure plasma glucose. It is used for the care of people with diabetes, as a monitoring tool, giving a guide to blood glucose levels, at a specific moment in time. Capillary blood glucose monitoring was first established in the 1970s using glucometers. With time, the use of glucometers has become easier and faster, with much smaller blood samples, yielding results in a matter of seconds. Today they are used routinely in health care, for the easier achievement of glycaemic targets and diabetic emergencies. Without such technology, intensive glucose control including insulin pump therapy would not have become a reality. Glucometers have also relieved a great amount of anxiety over the management of hypoglycaemia. Today however, we rely so much on capillary blood glucose measurements forgetting its limitations. This article will discuss the pitfalls and limitations of capillary blood glucose monitoring (1, 2). Accuracy goals for home glucose monitors The goals for glucometer accuracy have been quite variable. Clarke et al. proposed an accuracy grid to establish a more expansive set of goals for glucometer usage taking into account clinical accuracy, defined as within 20% of the laboratory glucose (3). For glucose levels above 75 mg/dl, the International Organization for Standardization (ISO) recommends a goal for glucometer error of within 20% when compared with a reference glucose sample, but Continue reading >>

Blood Glucose Monitoring

Blood Glucose Monitoring

Blood glucose monitoring is a way of testing the concentration of glucose in the blood (glycemia). Particularly important in diabetes management, a blood glucose test is typically performed by piercing the skin (typically, on the finger) to draw blood, then applying the blood to a chemically active disposable 'test-strip'. Different manufacturers use different technology, but most systems measure an electrical characteristic, and use this to determine the glucose level in the blood. The test is usually referred to as capillary blood glucose. Healthcare professionals advise patients with diabetes mellitus on the appropriate monitoring regimen for their condition. Most people with type 2 diabetes test at least once per day. The Mayo Clinic generally recommends that diabetics who use insulin (all type 1 diabetics and many type 2 diabetics) test their blood sugar more often (4-8 times per day for type 1 diabetics, 2 or more times per day for type 2 diabetics),[1] both to assess the effectiveness of their prior insulin dose and to help determine their next insulin dose. Purpose[edit] Blood glucose monitoring reveals individual patterns of blood glucose changes, and helps in the planning of meals, activities, and at what time of day to take medications.[2] Also, testing allows for quick response to high blood sugar (hyperglycemia) or low blood sugar (hypoglycemia). This might include diet adjustments, exercise, and insulin (as instructed by the health care provider).[2] Blood glucose meters[edit] Main article: Glucose meter Four generations of blood glucose meter, c. 1991–2005. Sample sizes vary from 30 to 0.3 μl. Test times vary from 5 seconds to 2 minutes (modern meters are typically below 15 seconds). A blood glucose meter is an electronic device for measuring the blood Continue reading >>

Use Of Capillary Blood Glucose For Screening For Gestational Diabetes Mellitus In Resource-constrained Settings

Use Of Capillary Blood Glucose For Screening For Gestational Diabetes Mellitus In Resource-constrained Settings

Use of capillary blood glucose for screening for gestational diabetes mellitus in resource-constrained settings Balaji Bhavadharini , Manni Mohanraj Mahalakshmi , Kumar Maheswari , Gunasekaran Kalaiyarasi , Ranjit Mohan Anjana , Mohan Deepa , Harish Ranjani , Miranda Priya , Ram Uma , Sriram Usha , Sonak D. Pastakia , Belma Malanda , Anne Belton , Ranjit Unnikrishnan , Arivudainambi Kayal , and Viswanathan Mohan Madras Diabetes Research Foundation and Dr. Mohans Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India Madras Diabetes Research Foundation and Dr. Mohans Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India Find articles by Manni Mohanraj Mahalakshmi Madras Diabetes Research Foundation and Dr. Mohans Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India Madras Diabetes Research Foundation and Dr. Mohans Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India Madras Diabetes Research Foundation and Dr. Mohans Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086 India Madras Diabetes Research Foundation and Dr. Mohans Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicab Continue reading >>

Blood Glucose Measurement – Osce Guide

Blood Glucose Measurement – Osce Guide

Introduction Wash hands Introduce yourself – state your name and role Confirm patient details – name / DOB Explain procedure: “I would like to check your blood glucose level.” “The procedure will involve taking a very small blood sample from your fingertip.” “You’ll experience a very brief sharp scratch.” Gain consent –“Do you understand everything I’ve said? Are you happy for me to go ahead?” Gather equipment Gloves Blood glucose reader Spring loaded lancet (a.k.a. “the finger pricker”) Testing strips – check expiry date is valid Gauze Measure the blood glucose 1. Ensure the patient has washed their hands – substances on the skin can alter the reading – avoid alcohol wipes as they can also interfere with the reading 2. Turn on the blood glucose monitor – ensure it is calibrated 3. Insert the test strip into the glucose monitor – ensure the strip is within date 4. Don gloves 5. Remove the protective cap from the lancet 6. Prick the patient’s finger – ideally the side of the finger (as this is usually less painful) 7. Gently squeeze the finger to produce a blood droplet 8. Touch the tip of the test strip against the droplet of blood 9. Apply gauze to the puncture site to stop the bleeding 10. Note the reading from the blood glucose meter To complete the procedure… Dispose of lancet into sharps bin Dispose of gloves and cotton wool into an appropriate clinical waste bin Wash hands Thank patient Document the blood glucose reading on the appropriate chart REVIEWED BY Continue reading >>

Capillary Versus Venous Bedside Blood Glucose Estimations

Capillary Versus Venous Bedside Blood Glucose Estimations

Abstract Objectives: To determine the mean difference and correlation between capillary and venous bedside glucose estimation in comparison to laboratory blood glucose analysis in emergency department (ED) patients. Methods: Blood glucose levels were synchronously analysed using a bedside blood glucometer on capillary and venous derived samples from consenting ED patients aged >12 years. The venous sample was sent for comparative testing using a laboratory based multichannel analyser. Mean difference and correlation coefficients were determined. Results: A total of 20 subjects (aged 13–88 years) were enrolled, with 100% data capture. The mean laboratory glucose was 7.075 mmol/l. The mean capillary blood glucose was 7.66 mmol/l (mean difference compared with mean laboratory glucose 0.58 mmol/l; 95% confidence interval 0.3 to 0.9). The mean venous derived blood glucometer glucose was 7.99 mmol/l (mean difference compared with mean laboratory glucose 0.91 mmol/l; 95% CI 0.6 to 1.2). The correlation coefficient for the laboratory blood glucose versus the capillary blood glucometer glucose was 0.97 mmol/l (p<0.001). The correlation coefficient for the laboratory blood glucose and the venous blood glucometer glucose was 0.96 (p<0.001). Variation occurred between the glucometer and the laboratory blood glucose results. Conclusions: There is a small but significant difference in the blood glucose results analysed on a bedside glucometer when the samples are taken from capillary or venous sources. Although good correlation is the norm between venous and capillary derived samples, caution must be exercised in accepting the results as equivalent or using either as substitutes for a laboratory blood glucose result. Continue reading >>

Variability Of Capillary Blood Glucose Monitoring Measured On Home Glucose Monitoring Devices

Variability Of Capillary Blood Glucose Monitoring Measured On Home Glucose Monitoring Devices

Go to: The 2011 American Diabetes Association position statements[1] on self-monitoring of blood glucose has recommended that glucose meter values an intermediate goal of limiting total error for 95% of samples to ≤ 15% at glucose concentrations ≥ 100 mg/dl and to < 15 mg/ dl at glucose concentrations < 100 mg/dL. International Organization for standardization (ISO) recommendations in 2003[2] proposed that for test readings >75 mg/dL, the discrepancy between meters and an accredited laboratory should be < 20% for glucose readings ≤ 75 mg/dL, the discrepancy should not exceed 15 mg/dL in 95% of the samples. Also, the Clinical and Laboratory Standards Institute (CLSI) proposed that 95% of the samples, the difference between meter and laboratory measurements of glucose < 20% when the laboratory glucose value is >100 mg/dL and < 15 mg/dL of the laboratory glucose value when the glucose concentration is <100 mg/dL. The Clarke Error Grid Analysis (EGA)[3] was developed in 1987 to quantify clinical accuracy of patient estimates of their current blood glucose as compared to the blood glucose value obtained in their meter. The grid breaks down a scatter plot of a reference glucometer and evaluated glucometer into 5 regions; A, B, C, D, and E. In a recent study in 2012 of 43 glucose meters, only 34 systems met ISO standards.[4] A recent study in April 2012 of two new glucometers demonstrated high accuracy compared to previous glucometers. However, current meters exhibit superior performance compared to previous meters. CGMS is still in its infancy with many studies documenting its benefits and also guidelines recommending its use in adults and children as outpatients. Its future use is going to be determined by its cost relative to its benefits. Analytical variability Detec Continue reading >>

How To Do Capillary Blood Glucose Monitoring

How To Do Capillary Blood Glucose Monitoring

While capillary blood glucose monitoring is most frequently recommended for people with diabetes, your doctor might also recommend the self-tests if you struggle with unstable blood sugar levels or during episodes of infection or other illness. Capillary blood glucose tests are simple and quick to perform; they require just a simple stick to the fingertip, a small drop of blood and a few minutes of patience. Before the Test Before pricking yourself with the lancet, take a minute to make sure you’re fully prepared. Make sure the test strips you’re planning to use were specifically designed for use with your blood glucose meter. Also, check the expiration date on the test strips; expired strips could give faulty results. Your blood glucose meter also likely recommends regular quality-control tests to ensure accuracy. Turn your meter on before you begin; perform the quality-control tests if directed to do so on the screen. The Basic Procedure After washing your hands, remove a test strip from the container and insert it into your blood glucose meter. Select a site on your fingertips you plan to prick; choose a location around the edges of your finger pads. Use the lancet to prick your finger in the desired location. When a drop of blood appears on the surface, touch the edge of the test strip to the blood drop -- the strip should draw the blood into the testing window. Apply pressure to your fingertip with a small gauze bandage while you wait for the test results. If the blood sample was obtained appropriately, the blood glucose meter should display your blood sugar on the screen within a few minutes. Know Your Numbers Although specific blood glucose target ranges vary from one person to the next, the American Diabetes Association recommends a general range for most he Continue reading >>

Capillary Glucose Meter Accuracy And Sources Of Error In The Ambulatory Setting

Capillary Glucose Meter Accuracy And Sources Of Error In The Ambulatory Setting

Glucose results derived from hand-held meters are used by patients and their health care team to make therapeutic decisions such as insulin dosing. Incorrect glucose values may result in both acute and also long-term therapeutic consequences. It is therefore essential that results are as accurate and precise as possible. Meter technology has shown incremental improvements since the introduction of the first commercially available hand-held meters in 1970s, including improvements in ease of use, technical performance and affordability.1-3Capillary glucose testing is an international multi-billion dollar industry.2 In New Zealand reimbursement of test strips for the 12 months to June 2009 was $19 million, accounting for 40% of PHARMAC’s entire diabetes ‘spend’. The number of meters available has expanded, both in New Zealand as well as internationally.1,2 Currently in New Zealand, six different meters are available for use with PHARMAC funded strips (see Table 1). It is therefore timely to describe current meter technology from a clinical perspective, highlighting some of the limits of meter performance. This review focuses on technical issues that impact on clinical interpretation of meter results in the ambulatory setting. It does not aim to be a comprehensive technical discussion. Although there are additional meter systems available in New Zealand with unsubsidised strips such as the Glucocard, which is used in many hospital inpatient settings, the focus of this review is meters with subsidised strips. Recent developments in meter technology have improved this testing system’s ease of use and analytical robustness.1-3 Test strips now require 8μL or less of blood (see Table 1). Using a low blood volume system has the following advantages: It allows most patien Continue reading >>

Beyond The Finger: Alternate Blood Sugar Testing Sites

Beyond The Finger: Alternate Blood Sugar Testing Sites

If you’re tired of the pain of finger sticking and the calluses that can develop over time, alternate site testing could be an option for blood sugar testing, especially for those who want to do frequent checks. In a study published in the Journal of Diabetes Science and Technology, researchers compared patients’ satisfaction with fingertip blood sugar testing and testing using an alternate site, in this case the palm of the hand. They found that people who test their blood sugar levels four times a day like the idea of using alternative site testing approaches. However, they also found that testing on their palm with regular lancing supplies didn’t always provide easy access to get enough blood for a test strip. Managing Diabetes With Alternate Site Testing: The Choices “The palm of the hand is good because it’s capillary blood and it’s going to be current blood sugar,” said certified diabetes educator Sacha Uelmen, RD, program director of the outpatient diabetes education program at the University of Michigan Health System in Ann Arbor. Your thumb is another option if you’re tired of using fingers. Other possible locations include the thigh, calf, upper arm, and forearm. However, sites other than your palm are recommended only if your blood sugar is stable at the time of testing. Certified diabetes educator Hector Verastigui, RN, clinical research coordinator at the Texas Diabetes Institute in San Antonio, said he teaches patients to test using their arms as an option if they are interested in alternate site testing. However, there are disadvantages to this method as well. “Most patients that I teach alternative site testing will say that forearm testing is less painful but difficult to obtain a blood sample, and most patients will return to fingerti Continue reading >>

Why Is My Finger Stick Often Different That The Laboratory Glucose Test?

Why Is My Finger Stick Often Different That The Laboratory Glucose Test?

Most of my old blogs were lost during the hacking attack and other website changes. I plan to update and repeat some of the previous blogs . We all use home glucose test to manage our diabetes . Home glucose testing has been one of the major improvements in the day to day management of diabetes. It is not perfect but it is still a fantastic improvement when I think about the old urine glucose test that we previously used to make treatment decisions. We assume that our home glucose test are accurate and we feel comfortable making management decisions based on those results. I believe that our home glucose test meet the requirements needed for very good glucose management. However, have you ever wondered why you finger stick capillary test is often different than the venous glucose test done in a laboratory. Lets take a little closer look at the glucose test processes. The meter you are using is require to have an error rate of < 20% at glucose levels of 30 to 400mg/dl. so our result could be somewhere between 65 and 95 mg/dl assuming an error rate of 19%. From my own personal experience in the hospital, where I frequently compared finger stick results with hospital lab. results, I believe the error rate on most meters is small and not a major issue. What else effects the results? The source of the blood effects the results. Arterial blood is about 5% higher than capillary blood and 10% higher than venous blood. You are not likely to be using arterial blood but you will be comparing capillary blood ( finger stick sample) to venous blood that is usually taken from your arm by a lab. Tech. This means ,that if you did a fingerstick test( capillary blood )at the same time as a laboratory test( venous blood) , your result may be a little higher than the lab result by about 5% Continue reading >>

Fasting Capillary Blood Glucose: An Appropriate Measurement In Screening For Diabetes And Pre-diabetes In Low-resource Rural Settings

Fasting Capillary Blood Glucose: An Appropriate Measurement In Screening For Diabetes And Pre-diabetes In Low-resource Rural Settings

Abstract Objective: To evaluate the efficiency of fasting capillary blood glucose (FCG) measurement as compared with fasting venous plasma glucose (FPG) measurement in screening diabetes and pre-diabetes in low-resource rural settings. Subjects and methods: In 2010, 993 participants were randomly selected from 9 villages in Yunnan province using cluster sampling method. Samples for FCG and FPG test were obtained after demographics and physical examination. The oral glucose tolerance test was performed in parallel as gold standard for diagnosis. Diagnostic capacities of the FCG measurement in predicting undiagnosed diabetes and pre-diabetes were assessed. The performance of FCG and FPG tests was compared. Results: Fifty-seven individuals with undiagnosed diabetes and 145 subjects with pre-diabetes were detected. The concordance between FCG and FPG levels was high (r=0.75, p<0.001). The area under the curve (AUC) for FCG test in predicting diabetes was 0.88 [95% confidence interval (CI) 0.82–0.93] with the optimal cutoff value of 5.65 mmol/l, sensitivity of 84.2%, and specificity of 79.3%. The corresponding values in FPG tests were 0.92 (95% CI 0.88–0.97) (AUC), 6.51 mmol/l (optimal cutoff point), 82.5% (sensitivity) and 98.3% (specificity), respectively. No significant difference was found in the AUC for the two screening strategies. Conclusion: FCG measurement is considered to be a convenient, practicable screening method in low-resource rural communities with acceptable test properties Continue reading >>

Performance Of An A1c And Fasting Capillary Blood Glucose Test For Screening Newly Diagnosed Diabetes And Pre-diabetes Defined By An Oral Glucose Tolerance Test In Qingdao, China

Performance Of An A1c And Fasting Capillary Blood Glucose Test For Screening Newly Diagnosed Diabetes And Pre-diabetes Defined By An Oral Glucose Tolerance Test In Qingdao, China

OBJECTIVE The study's goal was to evaluate the performance of A1C and fasting capillary blood glucose (FCG) tests as mass screening tools for diabetes and pre-diabetes, as determined by the standard oral glucose tolerance test (OGTT). RESEARCH DESIGN AND METHODS Data from 2,332 individuals aged 35–74 years who participated in a population-based cross-sectional diabetes survey in Qingdao, China, were analyzed. A 2-h 75-g OGTT was used to diagnose diabetes. The performance of A1C and FCG was evaluated against the results of the OGTTs by using receiver operating characteristic curve (ROC) analysis. RESULTS The prevalence of newly diagnosed diabetes and pre-diabetes (impaired fasting glucose and/or impaired glucose tolerance) was 11.9 and 29.5%, respectively. For subjects with newly diagnosed diabetes, the area under the ROC curve was 0.67 for A1C and 0.77 for FCG (P < 0.01) in men and 0.67 and 0.75 (P < 0.01) in women, whereas for pre-diabetes, these values were 0.47 and 0.64 (P < 0.001) in men and 0.51 and 0.65 (P < 0.001) in women. At the optimal A1C cutoff point of ≥5.6% for newly diagnosed diabetes, sensitivities (specificities) were 64.4% (61.6%) for men and 62.3% (63.3%) for women. CONCLUSIONS As a screening tool for newly diagnosed diabetes and pre-diabetes, the FCG measurement performed better than A1C in this general Chinese population. Type 2 diabetes has become a serious public health threat worldwide, and it leads to increased premature mortality and morbidity including blindness, renal failure, amputation, and cardiovascular disease. Diabetes and its complications may occur several years before a clinical diagnosis is made. Mass screening for diabetes can lead to an early diagnosis and timely treatment or intervention, which have been shown to reduce diabe Continue reading >>

Capillary Blood Glucose

Capillary Blood Glucose

There exists no universal, interdisciplinary standard for the teaching and practice of capillary blood glucose reagent strip testing, specifically with reference to the two aspects of the technique specified above. Grazaitis and Sexson (1980:221-223) report a case involving a neonate in whom a heel stick capillary blood glucose concentration measured with a reagent strip and reflectance photometer was 1. 1987:408-409) attempted to isolate the exact biochemical mechanism of the previously reported erroneous effect of isopropyl alcohol on reagent test strips used for capillary blood glucose analysis. The objectives of this study were to identify if any statistically significant difference existed between the capillary blood glucose concentrations of healthy volunteers tested using a commercially available capillary blood glucose reagent test strip and a reflectance photometer, comparing the results obtained (i) with and without the use of a 70% isopropyl alcohol solution to prepare the site of skin puncture and results obtained (ii) with and without alcohol using the first and second drops of blood. It was also hypothesised that significant differences in capillary blood glucose reagent test strip results between samples collected using the first and second drops of blood would be found, independent of the effect of 70% isopropyl alcohol. Continue reading >>

Original Article Should Capillary Blood Glucose Measurements Be Used In Population Surveys?

Original Article Should Capillary Blood Glucose Measurements Be Used In Population Surveys?

Abstract Objective To determine the accuracy and appropriateness of capillary blood glucose testing in population surveys. Materials and methods Capillary blood glucose using the Rochec ACCU-CHEK instrument and Advantage 11 Test Strips was compared to a laboratory instrument. Three independent cross-sectional risk factor surveys (n = 1432) and baseline individuals from the Greater Green Triangle Diabetes Prevention Project (n = 341) provided both fasting plasma and capillary blood glucose measurements. Accuracy of capillary glucoses was assessed using the ISO 15197 standard. The median age of the participants was 71 years, ranging from 25 to 84 years. There were 799 males and 974 females. Results Capillary glucose method had poorer precision at lower concentrations (CV: 9.50%, mean = 3.09 mmol/L, CV: 4.90%, mean = 16.78 mmol/L, n = 233 replicates). Individual discrepancies were seen across the measuring range (2.8–19.9 mmol/L, n = 1773). In total, 94.5% of results fell within the minimum acceptable accuracy standards. This was slightly short of the 95% of results required to meet the ISO 15197 standard. The prevalence of diabetes in the study population using glucose ⩾7.0 mmol/L was 2.4% (95%CI 1.8–3.3%) according to fasting plasma glucose and 2.8% (2.1–3.8%) according to fasting capillary glucose. The lower WHO-defined cut-off of 6.1 mmol/L for capillary blood glucose testing gave a prevalence of 10.7% (9.0–12.5%). Conclusions This study of matched capillary and plasma glucose results concludes that while it is appropriate to use fasting capillary glucose levels to determine the prevalence of diabetes in populations, it should not be used to reliably diagnose diabetes in individuals. Continue reading >>

Capillary Blood Glucose Monitoring

Capillary Blood Glucose Monitoring

Maureen Wallymahmed Nurse consultant, Aintree Hospitals NHS Trust, Diabetes Centre, Walton Hospital, Liverpool This article, the first in a series of articles relating to clinical skills in nursing, outlines the procedure of capillary blood glucose monitoring. This is a convenient way of monitoring blood glucose patterns and can be a useful aid in guiding treatment changes in patients with type 1 and type 2 diabetes, especially during periods of illness or frequent hypoglycaemia. Nursing Standard. 21, 38,35-38. doi: 10.7748/ns.21.38.35.s52 Continue reading >>

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