Sierra – Sacramento Valley EMS Agency EMT Finger Stick Blood Glucose Testing Expanded Scope (Updated 06/2017)

In order for EMT personnel to perform finger stick blood glucose testing utilizing a glucometer, they must: Be part of the organized EMS system, functioning under the oversight of an S-SV EMS approved BLS provider Be authorized by the approved BLS provider to perform finger stick blood glucose testing utilizing a glucometer Have received adequate training on finger stick blood glucose testing utilizing a glucometer

Finger Stick Blood Glucose Testing By EMT Personnel Education/Training Purpose Provide a review of diabetes and diabetic emergencies Provide education/training to EMT personnel on performing finger stick blood glucose testing using a glucometer Provide instruction on what to do with the blood glucose testing results

Finger Stick Blood Glucose Testing By EMT Personnel Education/Training Objectives Review diabetes and diabetic emergencies Describe finger stick blood glucose testing indications Describe finger stick blood glucose testing procedure Describe proper disposal of sharps/contaminates Describe what to do with the blood glucose testing results Treatment Informing other appropriate personnel Documentation

Review of Diabetes and Diabetic Emergencies Finger Stick Blood Glucose Testing Indications

Finger Stick Blood Glucose Testing By EMT Personnel Diabetes Mellitus Type 1 Diabetes The body stops producing insulin or produces too little insulin to regulate blood glucose levels Type 2 Diabetes The pancreas secretes insulin, but the body is partially or completely unable to use the insulin (insulin resistance)

Finger Stick Blood Glucose Testing By EMT Personnel Type 1 Diabetes 10% of diabetic patients Early onset (childhood/adolescence) No known prevention All patients insulin dependent Increased risk of infections, kidney disease, ocular disease, nerve injury, hypertension, coronary artery disease and stroke

Finger Stick Blood Glucose Testing By EMT Personnel Type 2 Diabetes 90% of diabetic patients Associated with: Older age Obesity Family history of diabetes History of gestational diabetes Impaired glucose metabolism Physical inactivity Race/ethnicity (more prevalent among Hispanics, Native Americans, African Americans and Asians)

Finger Stick Blood Glucose Testing By EMT Personnel Type 2 Diabetes (cont.) Increased risk of infections, kidney disease, ocular disease, nerve injury, hypertension, coronary artery disease and stroke Can be controlled with diet, exercise, weight loss Patients frequently take oral medications and/or insulin

Finger Stick Blood Glucose Testing By EMT Personnel Finger Stick Blood Glucose Testing Indications Altered level of consciousness (ALOC) Unresponsive Seizure/post-seizure Suspected diabetic emergency Suspected stroke, including the following: Weakness, facial droop, slurred speech Aphasia (inability to speak), dysarthria (difficulty pronouncing words), hemiparesis (one-sided weakness), or hemiplegia (inability to move one side of the body)

Finger Stick Blood Glucose Testing By EMT Personnel What Are We Measuring Amount of glucose in the blood (serum glucose level) Normal serum glucose level 100 mg/dl Fluctuates between 70 – 150 mg/dl

Finger Stick Blood Glucose Testing By EMT Personnel Blood Glucose Level Untreated diabetes results in high blood glucose levels

Finger Stick Blood Glucose Testing By EMT Personnel Hyperglycemia and Hypoglycemia Both can lead to diabetic emergencies Hyperglycemia – blood glucose is above normal Lack of insulin Results in Diabetic Ketoacidosis (DKA) if untreated Hypoglycemia – blood glucose is below normal Results in unresponsiveness/hypoglycemic crisis/diabetic coma if untreated

Finger Stick Blood Glucose Testing By EMT Personnel

Glucometer Blood Glucose Measuring Devices

Finger Stick Blood Glucose Testing By EMT Personnel Glucometer Blood Glucose Measuring Devices Samples of glucometers used to check blood glucose levels

Finger Stick Blood Glucose Testing By EMT Personnel Glucometer Use Equipment needed: Exam gloves Glucometer Test strip Alcohol prep pad Gauze pad Band-Aid Lancet Sharps Container

Finger Stick Blood Glucose Testing By EMT Personnel Glucometer Device Variations Some glucometers turn on automatically when the test strip is inserted – be familiar with the instructions of the specific device your organization utilizes

Finger Stick Blood Glucose Testing By EMT Personnel Glucometer Utilization and Care Follow manufacturers specific utilization instructions, which may include: Verification of proper test strip batch number Calibration Routine control testing Handle with care Do not expose to excessive heat, humidity, cold, dust, or dirt Store device in manufacturer provided case Clean per manufacturer instructions

Finger Stick Blood Glucose Testing By EMT Personnel Causes of Glucometer Device Errors Improper calibration Lack of cleaning/ maintenance Battery failure Test strip failure Codes on test strips and glucometer do not match

Finger Stick Procedure

Finger Stick Blood Glucose Testing By EMT Personnel Choose Appropriate Site Best locations are the 3rd and 4th fingers on the non- dominant hand Avoid the 2nd and 5th fingers if possible Perform the stick off to the side of the center of the finger Never use the tip or center of the finger

Finger Stick Blood Glucose Testing By EMT Personnel Massage or Warm Site Avoid fingers that are cold, cyanotic, swollen, scarred, or covered with a rash Massage to warm the finger and increase blood flow by gently squeezing from palm to fingertip 5 – 6 times

Finger Stick Blood Glucose Testing By EMT Personnel Clean and Dry Site Cleanse fingertip with alcohol prep Caution: alcohol can falsely elevate or lower blood glucose levels Wipe dry with clean gauze or allow to air dry

Finger Stick Blood Glucose Testing By EMT Personnel Using a sterile lancet, make a skin puncture just off the center of the finger pad Wipe away the first drop of blood (which tends to contain excess tissue fluid)

Finger Stick Blood Glucose Testing By EMT Personnel Finger Stick (cont.) If necessary, apply light pressure to surrounding tissue until another drop of blood appears Avoid “milking” – do not squeeze or apply strong repetitive pressure to site – this may result in hemolysis or increase tissue fluid in the blood causing incorrect testing results

Finger Stick Blood Glucose Testing By EMT Personnel Finger Stick (cont.) Free flowing blood is necessary to obtain reliable results Increased pressure beyond what is necessary to hold the finger can result in inaccurate results The drop of blood must be big enough to fill the strip completely

Finger Stick Blood Glucose Testing By EMT Personnel Finger Stick (cont.) Properly discard the lancet into an approved sharps container and discard any bloody dressings into an appropriate bio-hazard waste container Apply Band-Aid to puncture site

What To Do With The Results

Finger Stick Blood Glucose Testing By EMT Personnel Treatment If blood glucose results are ≤ 60 mg/dL (or slightly above 60 mg/dL and patient history and clinical picture fits hypoglycemia): Administer pre-packaged glucose solution/gel or 2 – 3 tablespoons of sugar in water/juice ONLY if patient is conscious and able to swallow

Finger Stick Blood Glucose Testing By EMT Personnel Treatment (cont.) If blood glucose results are > 60 mg/dL (and patient history and clinical picture does not fit hypoglycemia): Monitor & reassess Provide appropriate treatment based on patient condition

Finger Stick Blood Glucose Testing By EMT Personnel Other Responsibilities Inform other appropriate EMS providers and/or the receiving hospital of the blood glucose testing results Adequately document the blood glucose testing results