RISK FOR UNSTABLE BLOOD GLUCOSE
At risk for variation of blood glucose/sugar levels from the normal range.
· Deficient knowledge of diabetes management
· Developmental level
· Dietary intake
· Inadequate blood glucose monitoring
· Lack of acceptance of diagnosis
· Lack of adherence to diabetes management
· Physical activity level
· Physical/mental health status
· Weight gain or loss
The patient will
· Be free from symptoms of hypoglycemia/hyperglycemia.
· Have serum glucose to the prescribed desired range.
· Verbalize understanding of how to control blood glucose level.
Interventions and Rationales:
Assess patient for symptoms of low serum glucose level and maintain a patient airway if indicated. A low serum glucose may not be detected in some patients until moderate to severe central nervous system impairment occurs, which can lead to a compromised airway and cardiac arrest.
Assess for the underlying cause (e.g., inadequate dietary intake; illness such as nausea, vomiting, or diarrhea; and too much insulin) to help patient prevent future episodes and adapt treatment strategies and lifestyle changes.
Monitor or instruct patient to monitor glucose levels with a glucometer at regular intervals to identify and respond early to fluctuations in glucose levels that occur outside normal parameters.
Assess family understanding of prescribed treatment regimen. The family plays an important role in supporting the patient.
Assess patient’s knowledge of hypo/hyperglycemia to ensure adequate management and prevent future episodes.
Monitor for signs and symptoms of hyperglycemia (polyuria, polydipsia, polyphagia, lethargy, malaise, blurred vision, and headache). Early detection ensures prompt intervention and management.
Assess for the underlying cause of elevated serum glucose level, including inadequate dietary intake, illness, and poor medication management to prevent future episodes and develope treatment strategies such as changes in lifestyle.
Perform immediate finger stick with a glucometer to determine glucose level, which will guide treatment strategies. Administer insulin, as prescribed, to treat elevated blood glucose levels.
Provide patient with glucose tablets or gel if he or she is conscious and has ability to swallow. Administer intravenous glucose if patient is unconscious or cannot swallow. Immediate treatment in the form of oral or intravenous glucose must be administered to reverse the low serum glucose level. If patient becomes nauseated, turn patient on side to prevent aspiration.
Protect patient from injuries, such as falls. Symptoms of low serum glucose place patient at risk for injury especially when driving and performing other potentially dangerous activities.
Evaluate serum electrolyte levels. Administer potassium, as prescribed. With elevated blood glucose levels, potassium and sodium levels may be low, normal, or high, depending on the amount of water loss. Consider performing serum testing for HgbA1c (glycosylated hemoglobin A3C level) to evaluate average blood glucose levels over a period of approximately 2–3 months and to assess the adherence and effectiveness of the treatment regimen.
Teach patient and family self-management of hypoglycemia and hyperglycemia including glucose monitoring at regular intervals to treat abnormal glucose levels early and medication management, nutritional intake, exercise, and regular follow-up visits with the physician to ensure adequate understanding and management of the treatment regimen to prevent future hyperglycemic events. Patient and family teaching may include referrals to a diabetic educator, diabetic education classes, and a dietician.
Consult physician if signs and symptoms persist. Changes in prescribed medications may be needed, such as with oral hypoglycemic agents or insulin dosing. Call for emergency medical services if patient is unstable outside the hospital.
Oldroyd, J., et al. (2006). Randomized controlled trial evaluating lifestyle interventions in people with impaired glucose tolerance. Diabetes Research and Clinical Practice, 72(2), 117–127.