Risk for Unstable Blood Glucose

Risk for Unstable Blood Glucose: At risk for variation of blood glucose levels from the normal range that may
compromise health.
Risk factors
 Inadequate blood glucose monitoring
 Lack of adherence to diabetes management
 Medication management
 Deficient knowledge of diabetes management
 Developmental level
 Lack of acceptance of diagnosis
 Stress
 Sedentary activity level
 Insulin deficiency or excess
Possibly evidenced by
 [Not applicable for risk diagnosis. A risk diagnosis is not evidenced by signs and symptoms, as the
problem has not occurred and nursing interventions are directed at prevention.]
Desired outcomes
 Patient has a blood glucose reading of less than 180 mg/dL; fasting blood glucose levels of less than
<140 mg/dL; and hemoglobin A1C level <7%.
 May be related to
– lack of adherence to diabetes management
– inadequate blood glucose monitoring practices
– fluctuating physical activity level
– stress
 As evidenced by
– blood glucose levels below or above normal levels
 Desired Outcome
– identify factors that may lead to unstable blood glucose levels.
– verbalize understanding of balancing body and energy needs.
– verbalize plan in modifying identified risk factors to prevent shifts in glucose level.
– maintain blood glucose levels within normal range.

Tests:

• Fasting plasma glucose (FPG) • Hemoglobin A1c (A1c) test

• Oral glucose tolerance test (OGTT) • Random plasma (blood) glucose
Plasma glucose
Hemoglobin A
Fructosamine white blood cell (WBC) count and blood and urine cultures
beta-hydroxybutyrate level
urinary albumin (microalbumin), creatinine clearance, eGFR, CMP, BUN, creatinine, cystatin C
cholesterol and other lipids: cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, lipid profile
Nursing Interventions
Assess for signs of hyperglycemia.
Assess blood glucose level before
meals and at bedtime.
Monitor patient’s HbA1c-
glycosylated hemoglobin.
Assess for anxiety, tremors, and
slurring of speech. Treat
hypoglycemia with 50% dextrose.
Assess feet for temperature, pulses,
color, and sensation.
Assess the patient’s current
knowledge and understanding
about the prescribed diet.
Assess the pattern of physical
activity.
Monitor for signs of hypoglycemia.
Teach patient how to perform home Blood glucose is monitored before meals and at bedtime.
glucose monitoring.
Monitor urine albumin to serum
creatinine for renal failure.
Instruct patient to take insulin as directed
 Rapid-acting insulin
Rationale
Hyperglycemia results when there is an inadequate amount of
insulin to glucose. Excess glucose in the blood creates an
osmotic effect that results in increased thirst, hunger, and
increased urination. The patient may also report nonspecific
symptoms of fatigue and blurred vision.
Blood glucose should be between 140 to 180 mg/dL. Non-
intensive care patients should be maintained at pre-meal levels
<140 mg/dL.
This is a measure of blood glucose over the previous 2 to 3
months. A level of 6.5% to 7% is desirable.
These are signs of hypoglycemia and D50 is treatment for it.
To monitor peripheral perfusion and neuropathy.
Nonadherence to dietary guidelines can result in hyperglycemia.
An individualized diet plan is recommended.
Physical activity helps lower blood glucose levels. Regular
exercise is a core part of diabetes management and reduces risk
for cardiovascular complications.
A patient with type 2 DM who uses insulin as part of the
treatment plan is at increased risk for hypoglycemia.
Manifestations of hypoglycemia may vary among individuals but
are consistent in the same individual. The signs are the result of
both increased adrenergic activity and decreased
glucose delivery to the brain, therefore, the patient may
experienced tachycardia, diaphoresis, dizziness,
headache, fatigue, and visual changes.
Glucose values are used to adjust insulin doses.
Renal failure causes creatinine >1.5 mg/dL. Microalbuminuria is
the first sign of diabetic nephropathy.
Have an onset of action within 15 minutes of administration.
The duration of action is 2 to 3 hours for Humalog and 3 to 5
 analogs: lisproinsulin hours for aspart.

(Humalog), insulin aspart

 Intermediate and Premixed concentration has an onset of action similar to that of

rapid: 70% NPH/30% rapid-acting insulin and a duration of action similar to that of
intermediate-acting insulin.
regular.

Nursing Interventions Rationale

Priority 1: Assess risks and contributing factors to unstable blood glucose

levels1

Certain risk factors like family history of

diabetes, history of poor glucose control,
Determine the client’s factors that may
poor exercise habits, eating disorders and
contribute to unstable blood glucose
failure to recognize changes in glucose
levels.
needs can result in blood glucose stability
problems.

Determine influence of client’s cultural

and religious factors affecting dietary
These factors may need to be addressed in
practices, taking responsibility for own
creating client’s healthcare plan.
care and expectations of healthcare
outcome.

Age, developmental stage, maturity level

Determine client’s awareness or ability to
and current health status affect client’s
be responsible for own healthcare plans.
ability to adhere to treatment plans.

Priority 2: Assist client in creating preventive strategies for unstable blood

glucose levels

The blood glucose monitoring device is a

Ensure client is knowledgeable about handy and accurate way of assessing
using his own blood glucose monitoring blood glucose levels. Proper usage of this
device. device is essential in detecting unstable
blood glucose levels.

Educate about balancing food intake with Vital in preventing sudden increase or
physical activities. decrease in blood glucose levels.

Educate about adjusting home glucose

monitoring frequency depending on To quickly identify fluctuating blood
client’s risk factors like stress and poor
diet. glucose levels for immediate correction.

Blood glucose levels greatly depend on

Review and discuss client’s carbohydrate carbohydrate intake. It should be
intake. monitored and controlled closely when
stabilizing high blood glucose levels.

Essential in ensuring client’s

Discuss how the client’s anti-diabetic
understanding of his treatment regimen to
medications work.
ensure his compliance and adherence.

Priority 3: Ensure effective and safe treatment for clients on insulin therapy

It is important to regularly check for the

Emphasize importance of inspecting insulin’s expiration date,
client’s own insulin medication. cloudiness/clearness and storage to ensure
drug efficacy.

Different types of insulin have different

Discuss the different types of insulin as administration methods as well. Knowing
well as each type’s administration and following proper administration
method. method is important in ensuring drug’s
efficiency.

Insulin absorption is affected by the

integrity of injection sites. Insulin is less
Check injection sites.
absorbed in hypohypertropic or lumpy
tissues.

Priority 4: Promote wellness

Review client’s risk factors and provide

Ensures prevention of unstable blood
information on how to avoid
glucose levels in the future.
complications.

Refer client to a dietitian to plan specific

dietary needs based on complicated
To balance dietary intake with complicated
situations like pregnancy, growth spurt
body needs.
and change in activity level following an
injury.

Provide information about community

For client’s access to additional resources
resources, support groups and diabetic
for diabetes management.
educators.