Blood glucose monitoring allows you to see if the person’s blood glucose level is within their target range. This helps to avoid low blood glucose (hypoglycaemia) and high blood glucose (hyperglycaemia) levels and reduce the risk of diabetes-related complications. It also helps to make sure an older person’s diabetes management plan is working. An older person’s recommended target range can change over time, as they get older or as their health needs change. Jump to resources Low blood glucose levels (hypoglycaemia) Low blood glucose levels, also called hypoglycaemia or a hypo, is when blood glucose levels are below the person’s target range. It can happen in people who inject insulin or take certain diabetes medicines. Hypoglycaemia can happen quickly, and it can be fatal in older people. Hypoglycaemia does not happen in people who manage their diabetes through a healthy eating plan without using medicines. Signs and symptoms of hypoglycaemia Early symptoms of hypoglycaemia are not always recognised by older people. Important: This may mean that the first signs are noticed by you or others involved in their care, and include: a change of colour in their face – either pale (which is more usual) or flushed difficulty speaking vagueness a change in behaviour (for example, aggression or being weepy, happy, dreamy or relaxed when they are not usually) napping before meals loss of balance, or falls hallucinations or confusion. Treating hypoglycaemia A hypo needs to be treated immediately even if there are no obvious symptoms. If it is not treated quickly, their blood glucose level may continue to fall, and their condition may progress to: confusion loss of consciousness seizures in extreme cases, coma, and death. DO NOT leave the older person alone if they are having a hypo. If you are not trained in how to treat a hypo, call for a supervisor immediately and/or follow your service’s policy and procedures. Important: Always report a suspected or an episode of hypoglycaemia to your supervisor or registered nurse and follow your service’s policy and procedures. High blood glucose levels (hyperglycaemia) A high blood glucose level, also called hyperglycaemia, can happen in anyone who has diabetes. A high blood glucose level can affect older people differently and sometimes their symptoms can change over time. It often happens slowly but it can also happen suddenly, depending on the cause. Left untreated, hyperglycaemia increases the risk of diabetes-related complications and hyperglycaemic emergencies that require hospital admission. Signs and symptoms of hyperglycaemia Many older people may also find their hyperglycaemia symptoms are not obvious, and some may have no symptoms at all. Important: This may mean that the first signs are noticed by you or others involved in their care. The higher and more consistently elevated blood glucose levels are, the more obvious the symptoms can be, and include: drier than normal skin and lips urinary tract infection increased or excessive amounts of urine poor healing oral or genital thrush sunken eyes abnormal fatigue (the person may spend the day sleeping in a chair) abnormal vagueness or disinterest a fruity smell on the breath (in people with type 1 diabetes) difficulty in rousing thirst (although this is often absent in older people). Causes of hyperglycaemia Too little insulin or diabetes medicine Food intake not being covered adequately by insulin or diabetes medicine Excess carbohydrate consumption A decrease in activity Illness, infection, injury or pain Emotional stress Medicine used to treat other illnesses, such as steroids Their insulin pump not working properly (this can bring on hyperglycaemia suddenly). Treating hyperglycaemia If you are concerned that the older person may have symptoms of hyperglycaemia, or you think ‘something is not right’ – let your supervisor or registered nurse know. Follow your service’s or facility’s policy and procedures related to hyperglycaemia management. More information for aged care professionals For home care workers Check your client’s individualised care plan for their blood glucose monitoring requirements and target blood glucose range, if applicable. Remember to review it regularly as details will be updated if treatment has changed. Important information for hypoglycaemia episodes: If you witness a hypo or suspected hypo in an older person you are caring for, or if they tell you they have had a hypo, always report it to your supervisor or registered nurse and follow your service’s policy and procedures. The older person may need to visit their GP for review. Important information for hyperglycaemia episodes: If you are concerned that the older person may have symptoms of hyperglycaemia, or you think ‘something is not right’ – escalate and let your supervisor or registered nurse know, and follow your service’s policy and procedures. For residential aged care workers Target blood glucose levels (BGLs) should be documented for each resident and reviewed regularly by their healthcare team. It should also be clearly documented if the older person does their own blood glucose monitoring. The frequency and timing of blood glucose monitoring should be tailored to each person and documented in their individualised care plan and may be different depending on whether the older person has type 1 or type 2 diabetes. As per your facility’s policy and procedures notify your supervisor or registered nurse immediately if the resident is outside their target blood glucose range. Hypoglycaemia Hypo management plans should be available and individualised to the resident and documented in their individualised care plan. They should be reviewed regularly. Hyperglycaemia High BGLs are usually considered hyperglycaemia when they are consistently above 10 mmol/L but for residents in aged care this can be a BGL above 15 mmol/L. It is important to recognise why a resident’s blood glucose is too high, especially if they are feeling unwell. Unlike hypoglycaemia, high BGLs may creep up over hours or days, so it is important that BGLs are checked regularly and more frequently. Remember to regularly read the resident’s individualised care plan as details will be updated if treatment has changed. For residential aged care managers Target BGLs should be set for all residents living with diabetes. These should be reviewed regularly by the resident’s health care team. Hypoglycaemia management Hypoglycaemia is generally defined as a BGL of less than 6 mmol/L – especially in frail older people on insulin or a sulphonylurea. However, targets may be different for each resident, as tailored by their healthcare team. Your facility’s policy and procedures must reflect evidence-based practice for recognising and treating hypoglycaemia. Hyperglycaemia management For residents in aged care, hyperglycaemia is defined in the McKellar guidelines as a BGL above 15 mmol/L. However, this should be determined individually and clearly documented in the older person’s individualised care plan. You can audit your service’s diabetes management policies and practices using the NDSS Quality Review Tool. For registered nurses To avoid hypoglycaemia and hyperglycaemia, target BGLs should be set and reviewed regularly by the resident’s health care team. Tailor the frequency and timing of blood glucose monitoring to each resident and document this in their individualised care plan. Hypoglycaemia management For older people in residential aged care, hypoglycaemia is defined as a BGL below 6 mmol/L (according to the McKellar guidelines). This level is higher than for general patients, and is especially important in frail older people using insulin or sulphonylureas. However, blood glucose targets may be tailored for the resident by their healthcare team. DO NOT withhold medication or insulin unless advised to do so by the resident’s doctor. Read your service’s policy and procedures related to hypos, as these very between states and territories. Hyperglycaemia management For residents in aged care, hyperglycaemia is defined as a BGL above 15 mmol/L. However, blood glucose targets should be individualised and clearly documented in the older person’s individualised care plan. Left untreated, hyperglycaemia increases the risk of hyperglycaemic emergencies, such as diabetic ketoacidosis (DKA) for type 1 diabetes, and hyperosmolar hyperglycaemic states (HHS) for type 2 diabetes. These require hospital admission and impact on mortality and quality of life. Regular blood glucose monitoring enables hyperglycaemia to be treated before DKA and HHS develop and helps avoid hospital admission. Featured resources Diabetes management in aged care fast facts Home care provider hypo management plan Monitoring blood glucose – Six minute intensive training poster Hypoglycaemia – Six minute intensive training poster Find more resources
