hypoglycemia

You tell T.R. to check his blood glucose at 1230 then eat lunch at the normal time. You determine that he understands your teaching regarding averting hypoglycemia if he states:

"I need to eat within 30 minutes of taking the regular insulin."

List 4 additional points you would stress in a teaching plan with T.R.

Alcohol can increase insulin secretion, thus result in a low blood sugar (hypoglycemia). - Avoid drinking on an empty stomach. Avoid binge drinking and/or sustained drinking. - The s/s of hypoglycemia may be similar to those s/s of drunkenness. It is also possible that hypoglycemic s/s can occur for up to a 16 hour time period following heavy drinking. - Avoid any sugary drink. Drink something that has a low carbohydrate count. - He should carry an ID bracelet stating he is a Type 1 diabetic - He should carry glucose tablets on him or obtain a prescription for glucagon emergency kit

He goes on to say he has had "a little bit much to drink at a few of the parties he has been to" on the weekends. What effect does alcohol have on blood glucose?

Alcohol consumption can cause an increase in insulin production/secretion, which will result in low blood sugar.

What should you teach T.R. about alcohol consumption and managing his diabetes?

Completely eliminating or limiting alcohol consumption is the most effective solution. However, if T.R. is insistent on drinking alcohol, it should be recommended that he practice moderation, eat before drinking, avoid any sugary drink, monitor his blood sugar, and make his condition known. It is also important that T.R. understand that alcohol can adversely react with his medication regimen. - The preferred alcohol to drink would be light beer or dry wine because it has a fewer carbohydrate count. It also does not have a high sugar count, either.

What further action do you need to take at this time

Continue to monitor blood glucose level, level of consciousness, and orientation.

What is the first action you would take

First, I would have T.R. sit down, and then I would check his glucose level.

If no glucose meter were available, would you treat T.R. on the assumption he is hyperglycemic or hypoglycemic? Explain your reasoning.

I would treat T.R. on the assumption that he was hypoglycemic. I would assume that he was hypoglycemic because his friend stated that he found him wandering aimlessly, appearing pale and sweaty, which are all signs of hypoglycemia.

When you enter the room to give the juice, T.R. is not responsive enough to drink the juice safely. What should you do?

If T.R is unable to safely consume fruit juice or use oral glucose then subcutaneous glucagon would be the next step for blood sugar stabilization.

What would your next action be?

If T.R. is alert and oriented I would be giving cheese and crackers or mixed nuts - combining carbs and protein is the best way to continually raise blood pressure (15g) While having T.R. eat the snack blood sugar checks should be done every 15 minutes

Which assessment findings would support the premise that T.R. is experiencing a hypoglycemic reaction?

Nervousness and tachycardia

Based on your knowledge of the types of insulin T.R. is receiving, when would you expect T.R. to experience a hypoglycemic reaction

Lantus peaks: 6 hours = 1:45 Humulin R peaks 2-4 hours = 9:45-11:45

At 1110, you recheck T.R.'s glucose and the reading is 104 mg/dL (5.8 mmol/L). What should you do now?

Monitor patient per protocol Give patient meal or snack within 30 minutes Evaluate etiology of hypoglycemia Educate patient on how to prevent future episodes

why did T.R. experience this episode of hypoglycemia?

T.R. experienced hypoglycemia because an apple is not a large enough meal to provide T.R. with the nutrients to be converted into glucose to maintain glycemic control. Too much insulin was given for the meal provided

T.R. says he had a few similar episodes recently. He treated them by eating a candy bar. He says he is on a 2000-calorie, carbohydrate-controlled diet but has been checking his blood glucose levels every "couple of days" only. What common mistake in previously treated episodes of hypoglycemia did T.R. make?

T.R. is not checking his blood sugar level as often as he should be; this should be done thrice daily before each meal, and also before bedtime. - Based upon the information given in the progress report, T.R. is taking his insulin without checking his blood sugar level beforehand. He is also eating little food after taking the insulin. If his blood sugar already was low, insulin would make it even lower, thus putting him in danger of a hypoglycemic episode. Glargine and Regular insulin have the longest lasting peak effect on the body, as well. Long lasting insulin should be given at bedtime to regulate the blood sugar level overnight.

It is 1025. T.R.'s glucose reading is 50 mg/dL (2.8 mmol/L). What should your next action be

T.R. should be given a sugary drink such as fruit juice. This will help increase his blood sugar level. Rest would also be suggested. Give TR 15 grams of simple carb (3 oz fruit juice/soda, 7 life savers, 8 oz milk, 2 tbsp raisins, 1 tbsp sugar, honey, corn syrup, or 3 glucose tablets) Follow this with a complex carb and protein snack such as meat, cheese, PB with crackers

At 1045, you recheck T.R.'s glucose and the reading is 64 mg/dL (3.6 mmol/L). His vital signs are 120/72, 18, 92. Has his status improved or not? Defend your response.

T.R.s heart rate has decreased, less tachycardic Respiratory rate remains in normal range Blood pressure is in normal range Blood sugar has risen and although it is not in normal range it is a good sign that it is steadily increasing

T.R.'s breathing rate is 16 and he has a pulse of 112 and regular. Because outpatient resources vary, describe your next actions if (1) your clinic is well equipped for emergencies or (2) your clinic has no emergency supplies.

Well equipped - administer 75-80ml of 20% glucose or 150-160ml of 10% glucose intravenously Not well equipped - administer subcutaneous glucagon, support respirations, seizure precautions and call emergency personnel

What questions would you ask to find out what precipitated this event

You should ask T.R. when the last time he took his insulin was and when his last meal was/what he had to eat. You can ask if he has had this happen to him in the past. How often he checks his blood sugar