Diabetes
There are two primary methods for evaluating a patient’s blood sugar control. Measurement of blood glucose can provide valuable information about how blood sugar levels fluctuate throughout the day and in response to specific dietary and behavioral activities (i.e. food and exercise). A1C measurement provides information about the average blood sugar level for the previous 90 days. Both tests can be accomplished in less than ten minutes and provide valuable information needed to evaluate current therapy.
Using a glucometer
Most glucometers work similarly, and therefore we provided a video on how to use the Accu-Check glucometer. Click here to learn how to use the Accu-Check glucometer.
POC Glucometer Goals:
Fasting Blood Glucose: 80-130 mg/dL
2-hours Post Prandial: <180 mg/dL
- Blood Glucose Alarm Values
- > 200 mg/dL (if >240mg/dL it is important to test for urine ketones)
- If ketones are detected, seek immediate medical attention
- < 70 mg/dL
- Treat severe hypoglycemia with Glucagon, if available
- Treat with 15g glucose, wait 15 min and then recheck blood glucose
- If >70 mg/dL, patient should eat a small meal
- If <70 mg/dL, treat with 15g glucose, wait 15 min, then recheck
- If blood glucose continues at <70 mg/dL, call 9-1-1
Measuring A1c
- Afinion Test System instructions
- A1c Now Disposable testing kit instructions
| A1c Goals | A1c Percentage |
| Diabetes Diagnosis | |
| More Stringent | <6.5% |
| Normal | <7% |
| Less Stringent | <8% |
| No diabetes diagnosis | |
| Normal | < 5.7% |
| Prediabetes | 5.7 – 6.4% |
| Test for diabetes | >6.4% |
Hypertension
Uncontrolled blood pressure puts a patient at risk for stroke, heart disease, kidney disease, and much more. Providing checks allows patients to know where their blood pressure is without having to schedule an appointment with their physician. Measuring blood pressure at each pharmacy visit provides an opportunity to identify the need to educate patients and/or modify therapy.
Preparation
Before checking a patient’s blood pressure, make sure the patient:
- Hasn’t had caffeine or nicotine in the past 30 minutes
- Is seated and relaxed for at least 5 minutes
- Legs are not crossed, and feet are flat on the floor
- Is not talking during the measurement
- Arm is supported, relaxed, and at heart level
Blood pressure assessment
| Systolic Blood Pressure (mmHg) | Diastolic Blood Pressure (mmHg) | ||
| Hypotension | < 90 | OR | < 60 |
| Normal | < 120 | AND | < 80 |
| Elevated | 120-129 | AND | < 80 |
| Stage 1 hypertension | 130-139 | OR | 80-89 |
| Stage 2 hypertension | ≥ 140 | OR | ≥ 90 |
| Alarm Value* | ≥ 180 | OR | ≥ 120 |
*In the case of an alarm value, if the patient is experiencing no symptoms of end-organ damage, have the patient relax for 5 minutes and recheck blood pressure on the other arm.
*If the patient is experiencing signs/symptoms of end organ failure, call 9-1-1 and have the patient sent to the ER. Signs/symptoms include: chest pain, shortness of breath, back pain, numbness/weakness, change in vision, difficulty speaking/swallowing.
Cholesterol
Lipid management is important for the prevention of major adverse cardiac events. Testing allows assessment of the need for initiation of or modification of therapy.
