NCM_116 – RELATED LEARNING EXPERIENCE (SKILLS AND CLINICAL
DE LA SALLE LIPA – COLLEGE OF NURSING
ACADEMIC YEAR 2020-2021 / SECOND SEMESTER
CAPILLARY BLOOD GLUCOSE (CBG) EXAMINATION
STUDY GUIDE
Page 1 of 15
NCM_116 – RELATED LEARNING EXPERIENCE (SKILLS AND CLINICAL
DE LA SALLE LIPA – COLLEGE OF NURSING
ACADEMIC YEAR 2020-2021 / SECOND SEMESTER
CAPILLARY BLOOD GLUCOSE (CBG)
The level of circulating blood glucose as measured by glucometer analysis
of a finger stick sample
INDICATIONS:
• DIABETIC PATIENTS (Day-to-day management of patients with type 1 and type
2 diabetes)
• Detection of hypoglycemia.
• Detection of persistent hyperglycemia, for example, during periods of illness
Equipment:
Glucometer
Lancet
Glucometer strip
Clean gloves
Alcohol swab and dry cotton balls
Sharp container
Micropore
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NCM_116 – RELATED LEARNING EXPERIENCE (SKILLS AND CLINICAL
DE LA SALLE LIPA – COLLEGE OF NURSING
ACADEMIC YEAR 2020-2021 / SECOND SEMESTER
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NCM_116 – RELATED LEARNING EXPERIENCE (SKILLS AND CLINICAL
DE LA SALLE LIPA – COLLEGE OF NURSING
ACADEMIC YEAR 2020-2021 / SECOND SEMESTER
PROCEDURE:
1. Wash and dry hands before and after the procedures. Observe universal (standard) safety precautions.
2. Wear gloves at all time.
3. Check patient’s ID band, explain and secure consent for the procedures to the patient and provide privacy
4. Prepare all the equipment
5. Do Skin or site preparation using alcohol swab.
6. Prime the lancet to no more than 2.0 mm to minimize the risk of bone injury.
7. Remove the glucose testing strip without touching the sensor tip from the container. Insert glucose testing strip into the
glucometer; this often leads to the glucometer turning itself on.
8. Firmly apply lancet to the site of sample collection. Release the trigger on the lancet to pierce the skin.
9. Wipe away the first drop of blood with clean gauze or dry cotton as this drop of blood may contain intracellular or interstitial
fluid, or is hemolyzed, both of which could affect the blood sample.
10. Gentle downward pressure applied close to the puncture site may facilitate blood flow and collection of the second drop of blood.
11. Collect the second drop of blood as it forms by touching the tip of the glucose testing strip.
12. Place glucometer down and cover the site of skin puncture with a clean cotton or gauze. Pressure may need to be applied to stop
further bleeding from the puncture site.
13. The machine normally provides a result at this stage unless there have been errors in collection; for example, insufficient sample,
low battery, wrong code, or the machine times itself out. If an error displays on the glucometer, troubleshoot as appropriate.
14. Wash hands and replace equipment in storage bag container.
15. Make a note of test results relative to diet, exercise, and/or medication use as appropriate.
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NCM_116 – RELATED LEARNING EXPERIENCE (SKILLS AND CLINICAL
DE LA SALLE LIPA – COLLEGE OF NURSING
ACADEMIC YEAR 2020-2021 / SECOND SEMESTER
Question:
How much blood sample do we need? _____________ microL
What is the normal range of CBG? ___________________ mmol; ________________________ mg/dL
Advantages:
• Small blood sample
• Range of alternate sites capable of testing
• Short testing time
• Large display on glucometer
• Less painful than venipuncture.
Disadvantages:
• Manufactures often provide low cost or subsidized glucometers but sell testing strips and accessories at a significant profit
margin. The test strips are expensive, time-limited (short expiry dates), and are affected by a range of variables including
temperature, humidity, size, and quality of blood sample.
• Accuracy of the results is dependent on the clinical presentation of the client and may not be very reliable in clients with
hypoglycemia, anemia, altered hematocrit, hypotension, or those who are critically ill.
• Older machines may need calibration with test strips, and results could be compromised if the calibration is not undertaken
appropriately.
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NCM_116 – RELATED LEARNING EXPERIENCE (SKILLS AND CLINICAL
DE LA SALLE LIPA – COLLEGE OF NURSING
ACADEMIC YEAR 2020-2021 / SECOND SEMESTER
INSULIN PREPARATION AND ADMINISTRATION
What is insulin?
• Is a hormone secreted by the pancreatic beta cells that facilitates the uptake of
glucose into skeletal muscle and adipose tissue by increasing the number of
glucose transporters (GLUT 1 and GLUT 4) that facilitate glucose diffusion into
these targeted cells.
• A protein that contains 51 amino acids
• Lack of supply – the disease is known as Type 1 (IDDM or Juvenile onset) and Type 2 (NIDDM or adult onset) Diabetes
respectively.
• Insulin is a hormone that people with diabetes either cannot produce or do not efficiently use.
Insulin Action
• Fast-acting insulin replaces the surge of insulin that a healthy pancreas would release at mealtime.
• Long-acting insulin mimics the low-level flow of insulin that a healthy pancreas releases between meals and overnight.
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NCM_116 – RELATED LEARNING EXPERIENCE (SKILLS AND CLINICAL
DE LA SALLE LIPA – COLLEGE OF NURSING
ACADEMIC YEAR 2020-2021 / SECOND SEMESTER
Injection Site
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NCM_116 – RELATED LEARNING EXPERIENCE (SKILLS AND CLINICAL
DE LA SALLE LIPA – COLLEGE OF NURSING
ACADEMIC YEAR 2020-2021 / SECOND SEMESTER
• A person can inject insulin under the skin of the abdomen, upper arms, or thighs.
• Injections into the abdomen are the quickest route for insulin to reach the blood. The process takes a little more time from the
upper arms and is even slower from the thighs.
• It is important to stay consistent with the general injection area, but also to change the exact injection site frequently. Repeat
injections at the same spot on the skin can cause lumps to form under the skin. This makes it harder for the insulin to work.
Dosage
• Each type of insulin has its own suggested dose. These vary depending on the type of diabetes and any history of insulin use.
• When a person starts to use new insulin, the doctor will recommend that they begin with a smaller percentage of the target dose.
• This gives the body time to adapt to the extra insulin. The doctor will then slowly start to increase the prescription to provide a
full dose.
• Adjustments to an insulin regimen may become necessary if there are changes to a person’s diet or daily physical activity levels
or if a person becomes ill.
TYPE ONSET PEAK TIME DURATION
Categories
Divided in 4 major categories: Short and Rapid Acting 15-30 mins 1-3 hours Few hours
- Rapid acting
Long Acting Several hours No peak time (It works to regulate 24 hours or longer
- Short acting
blood sugar levels at a fairly stable
- Intermediate acting
rate throughout the day.
- Long acting
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NCM_116 – RELATED LEARNING EXPERIENCE (SKILLS AND CLINICAL
DE LA SALLE LIPA – COLLEGE OF NURSING
ACADEMIC YEAR 2020-2021 / SECOND SEMESTER
RAPID ACTING
Examples Appearance When it starts to The time of How long it lasts
work (onset) greatest effect (duration)
(peak)
Apidra (insulin glulisine)
Clear 10–15 minutes 1–1.5 hours 3.5–5 hours
Fiasp (faster-acting insulin Clear 4 minutes 0.5–1.5 hours 3–5 hours
aspart)
Humalog (insulin lispro) Clear 10–15 minutes 1–2 hours 3–4.75 hours
NovoRapid (insulin aspart) Clear 9–20 minutes 1–1.5 hours 3–5 hours
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NCM_116 – RELATED LEARNING EXPERIENCE (SKILLS AND CLINICAL
DE LA SALLE LIPA – COLLEGE OF NURSING
ACADEMIC YEAR 2020-2021 / SECOND SEMESTER
SHORT ACTING
Examples Appearance When it starts to The time of How long it lasts
work (onset) greatest effect (duration)
(peak)
Entuzity (insulin regular)
Clear 15 minutes 4–8 hours 17–24 hours
Humulin R, Novolin ge
Toronto (insulin regular) Clear 30 minutes 2–3 hours 6.5 hours
INTERMEDIATE ACTING
Examples Appearance When it starts The time of How long it lasts
to work greatest effect (duration)
(onset) (peak)
Humulin N, Novolin ge
NPH(insulin NPH) Cloudy 1–3 hours 5–8 hours Up to 18 hours
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NCM_116 – RELATED LEARNING EXPERIENCE (SKILLS AND CLINICAL
DE LA SALLE LIPA – COLLEGE OF NURSING
ACADEMIC YEAR 2020-2021 / SECOND SEMESTER
LONG ACTING
Examples Appearance When it The time of How long it lasts
starts to greatest effect (duration)
work (peak)
(onset)
Basaglar (insulin glargine
biosimilar) Clear 1.5 hours Does not apply 24 hours
Lantus (insulin glargine U-100)
Clear 1.5 hours Does not apply 24 hours
Levemir (insulin detemir U-300)
Clear 1.5 hours Does not apply 16 to 24 hours
Toujeo (insulin glargine U-300)
Clear 1.5 hours Does not apply Up to 30 hours
Tresiba (degludec)
Clear 1.5 hours Does not apply 42 hours
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NCM_116 – RELATED LEARNING EXPERIENCE (SKILLS AND CLINICAL
DE LA SALLE LIPA – COLLEGE OF NURSING
ACADEMIC YEAR 2020-2021 / SECOND SEMESTER
Short Acting
• Insulins take effect and wear off more quickly than long-acting insulins.
• A short-acting insulin is often used 30–60 minutes before a meal so that it has time to work.
• These liquid insulins are clear and do not settle out when the bottle (vial) sits for a while.
Intermediate and Long Acting
• Insulins contain added substances (buffers) that make them work over a long time and that may make them look cloudy.
• When these types of insulin sit for even a few minutes, the buffered insulin settles to the bottom of the vial. But insulin glargine
and insulin detemir are clear liquids (not cloudy).
MIXTURES:
• insulin can sometimes be combined in the same syringe, for example, intermediate-acting and rapid- or short-acting insulin. Not
all insulins can be mixed together.
• For convenience, there are premixed rapid- and intermediate-acting insulin. The insulin will start to work as quickly as the
fastest-acting insulin in the combination. It will peak when each type of insulin typically peaks, and it will last as long as the
longest-acting insulin. Examples include:
• 30% regular and 70% NPH (Humulin 30/70, Novolin ge 30/70).
• 50% lispro and 50% lispro protamine (Humalog Mix 50).
• 25% lispro and 75% lispro protamine (Humalog Mix 25).
• 30% aspart and 70% aspart protamine (NovoMix 30).
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NCM_116 – RELATED LEARNING EXPERIENCE (SKILLS AND CLINICAL
DE LA SALLE LIPA – COLLEGE OF NURSING
ACADEMIC YEAR 2020-2021 / SECOND SEMESTER
Insulin Injection Device
• Insulin syringes
• Syringes are manufactured in 30-unit (0.3 ml), 50-unit (0.5 ml) and 100-unit (1.0 ml)
measures. The size of the syringe needed will depend on the insulin dose. For example, it is
easier to measure a 10 unit dose in a 30 unit syringe and 55 units in a 100 unit syringe.
• The needles on the syringes are available in lengths ranging from 6–8 mm
Insulin pens
• Insulin pens
• Insulin companies have designed insulin pens (disposable or reusable) to be used with their
own brand of insulin.
• Disposable insulin pens already have the insulin cartridge in the pen. They are discarded
when they are empty, when they have been out of the fridge for one month, or when the use-
by date is reached.
Insulin Injection Devices
• Insulin pumps
• An insulin pump is a small programmable device that holds a reservoir of insulin and is worn outside the body. The insulin pump
is programmed to deliver insulin into the fatty tissue of the body (usually the abdomen) through thin plastic tubing known as an
infusion set or giving set. Only rapid-acting insulin is used in the pump.
• The infusion set has a fine needle or flexible cannula that is inserted just below the skin. This is changed every two to three days.
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NCM_116 – RELATED LEARNING EXPERIENCE (SKILLS AND CLINICAL
DE LA SALLE LIPA – COLLEGE OF NURSING
ACADEMIC YEAR 2020-2021 / SECOND SEMESTER
Factors that speed insulin absorption
• Injecting into an exercised area such as the thighs or arms
• High temperatures due to a hot shower, bath, hot water bottle, spa or sauna
• Massaging the area around the injection site
• Injecting into muscle – this causes the insulin to be absorbed more quickly and could cause blood glucose levels to drop too low.
Factors that delay insulin absorption
• Over-use of the same injection site, which causes the area under the skin to become lumpy or scarred (known as
lipohypertrophy)
• Insulin that is cold (for example, if insulin is injected immediately after taking it from the fridge)
• Cigarette smoking.
Disposal of syringe
• Used syringes, pen needles, cannulas and lancets must be disposed in sharps container, which is puncture-proof and has a secure
lid.
Insulin storage
• storing unopened insulin on its side in a fridge
• keeping the fridge temperature between 2 and 8°C
• making sure that insulin does not freeze
• once opened, keeping it at room temperature (less than 25 °C) for not more than one month and then disposing of it safely
• avoiding keeping insulin in direct sunlight.
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NCM_116 – RELATED LEARNING EXPERIENCE (SKILLS AND CLINICAL
DE LA SALLE LIPA – COLLEGE OF NURSING
ACADEMIC YEAR 2020-2021 / SECOND SEMESTER
• Extreme (hot or cold) temperatures can damage insulin so it doesn't work properly. It must not be left where temperatures are
over 30 °C.
INSULIN SAFETY
Don't use insulin if:
• clear insulin has turned cloudy
• cloudy insulin has lumps or flakes in it, or deposits of insulin are visible on the inside of the vial, pen fill or cartridge and cannot
be dissolved by gentle rotation
• expiry date has been reached
• it has been frozen or exposed to high temperatures
• a vial, pen fill or cartridge has been used or has been out of the fridge for longer than one month.
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