Blood glucose - accu ck vs lab draw

[weinerdog1]

I recently had a discussion with an intern at our hospital over a patient with a blood glucose of 364 (according to the lab value) vs an accu check done within minutes of the lab draw. The accu check was 312. Which should you treat for? I said the lab draw is probably the most accurate and was promptly told that we treat the accu check result of 312. If that's the case, why bother ordering a blood draw? Wanted to know what everybody's thoughts were about this. Thank you!

[canoehead, BSN, RN]

I consider the lab results more accurate.

[RNPATL, DNP, RN]

I agree ... the lab value would be the value I would use for treatment.

[meownsmile, BSN, RN]

Both could be accurate. Depending on time lapse between the time the accu-check was taken and the blood draw was done and processed in the lab a patient could drop or gain 50 points. My thought is you should treat for the most recent value.

We are having a discussion now also about whether they should cancel a BSBS when a CMP is ordered for morning. It is double charging for the same thing basically and could cut a great deal of time for the lab techs we have who come to the floor to do the fingersticks.

[hypnotic_nurse]

I'm learning a lot about diabetes recently because some of our newest and biggest studies deal with diabetes.

The CDEs I am working with tell me that the fingerstick accuracy depends a lot on the machine used...some are much more accurate than others (and when we compared fingersticks done at the same time with different brands of portables, they are seldom the same).

If you use a YSI machine (which is not portable; we are lucky enough to have one, though) and run the results as soon as they are drawn, that is considered the most accurate method for our studies...but the tubes have to be tested right away or they have to be centrifuged immediately for testing later.

According to two different MDs who are administering these studies, tubes sent to the lab can have differing values, depending on which type of tube it was drawn in (there are several you can use) and how quickly it was centrifuged.

I have not had time (we have 90 different protocols at this point so I am swamped) to look at the science or ask the lab personnel. I know for the studies, we use the YSI machine or have the lab run them STAT to get the most accurate measurement.