Manipulating Glucometer?

[lreddick]

Is it possible to manipulate a glucometer to get low blood sugar levels? I had a patient last night that showed a reading of 26.

I calibrated the glucometer before med pass, had her take her reading twice (both matched) and checked my reading on the facility glucometer against mine. After administration of glucose gel, her blood sugar went to 86, so she was fine.

When I got to work tonight, I was told by another nurse that she manipulated the glucometer to get a low reading so she could have a snack in the evening.

So, is it possible that she pulled one over on me and how?

[blondy2061h, MSN, RN]

I mean it's possible, by diluting the blood sample, but why would she? Glucose gel isn't exactly a delicious snack, and she'd have to manipulate all of those tests.

[dishes, BSN, RN]

Is it possible that the nurse is burnt out? Blaming patients can be a symptom of burn out.

[Sour Lemon]

If it's that difficult for patients to get a snack, that's a problem in itself.

[mmc51264, BSN, MSN, RN]

no, as others have said, diluting sample maybe, but no changing the machine.

[sevensonnets]

To somehow manipulate the glucometer she'd have to have access to it. Did you leave it at the bedside so that she was able to tamper with it?

[cleback]

I've seen some pretty drastic measures taken by residents to cheat their diet or fluid orders, but I have not seen that. To manipulate both glucometers would be on the scale of "Oceans Eleven." Seems pretty unlikely.

[TraviesaRN]

Is it common for this lady to have a BGL of 26 and not be symptomatic? Just curious as that is what stood out the most to me when I read this. That a 26 doesn't seem to be a big deal. You also said it was done twice which means she would have had to dilute it twice without your knowledge but that you also compared it again the facility one. (not exactly sure what you were meaning there, like if you used another machine and got the same result?)

[blondy2061h, MSN, RN]

TraviesaRN said:

Is it common for this lady to have a BGL of 26 and not be symptomatic? Just curious as that is what stood out the most to me when I read this. That a 26 doesn't seem to be a big deal. You also said it was done twice which means she would have had to dilute it twice without your knowledge but that you also compared it again the facility one. (not exactly sure what you were meaning there, like if you used another machine and got the same result?)

Long term diabetics can develope hypoglycemia unawareness and be asymptomatic and quite low blood sugars.

[macawake, MSN]

lreddick said:

I calibrated the glucometer before med pass, had her take her reading twice (both matched) and checked my reading on the facility glucometer against mine.

I don't quite understand the series of events here. Who does this glucometer belong to, the one that you calibrated before med pass? Does it belong to you or to the patient? Since you use the term "mine" I have to assume that it's yours, but could you please clarify? And if it is yours, do you leave it in the room with the patient having access to it when you're not there? ? And did you or the patient also check her blood glucose on your facility's glucometer or was the facility glucometer somehow only used for calibration? When you say that you "had her take her reading twice", were you there in the room?

Quote

After administration of glucose gel, her blood sugar went to 86, so she was fine.

Which glucometer was used for this post-"snack" reading? In my part of the world we measure blood glucose in mmol/L (and 26 would be a high level and 86 would be a freaky high reading). After converting your numbers I figure that 26 is quite low (symptomatic in most but not all people) and 86 is within normal limits. Have I got that right?

Isn't [26 +administration of glucose gel = 86] an outcome that could be realistically expected? To me that seems to corroborate that the initial low readings were in fact accurate. Or does the nurse you work with think that the glucometer used is tampered with so that it consistently shows too low numbers and that the patient's blood glucose in reality was higher than the 86 that the glucometer showed at the final reading?

On a slight tangent.. I'm surprised that Dishes' post has gotten so few "likes". I absolutely agree with her. I would be concerned about a coworker who made a claim like that about a patient unless that coworker could point to irrefutable proof that the glucometer had been tampered with. To me it sounds suspiciously like she might be unaware that some diabetics can have hypoglycemia without displaying symptoms normally associated with it. How would the other nurse have dealt with a reading of 26 if she'd been this patient's nurse for that shift?

[Double-Helix, BSN, RN]

macawake said:

Which glucometer was used for this post-"snack" reading? In my part of the world we measure blood glucose in mmol/L (and 26 would be a high level and 86 would be a freaky high reading). After converting your numbers I figure that 26 is quite low (symptomatic in most but not all people) and 86 is within normal limits. Have I got that right?

In the US, blood glucose is measured in mg/dL. Normal is about 70-110mg/dL.

The conversion factor for mmol/L is 18. So you'd divide 26mg/dL by 18 to get a reading of 1.44mmol/L. 86mg/dL would be 4.8mmol/L.

[TraviesaRN]

blondy2061h said:

Long term diabetics can develope hypoglycemia unawareness and be asymptomatic and quite low blood sugars.

That's why I was asking if it was common for this patient, because I have seen many long term chronic diabetics come into the ER altered and symptomatic with low BGL. I think the lowest I saw that wasn't symptomatic was in the mid 30's. I don't usually get nervous or show worry at work but in my work setting a 26 would be getting more than some glucose gel.

Then again we probably wouldn't be getting a pt for sugar that low if they weren't symptomatic so that's probably why it's rare for me to see. That's why I am always curious to read the variances in places.