How should I print the patient handout for a patient with a blood glucose of 600 mg/dL who is at risk for diabetic ketoacidosis?

How to Print Patient Handout for Blood Glucose 600 mg/dL at Risk for DKA

For a patient with blood glucose of 600 mg/dL, you must first determine whether this represents diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) before printing any educational materials, as the diagnostic criteria and patient education needs differ significantly between these two hyperglycemic crises.

Immediate Diagnostic Assessment Required

A glucose of 600 mg/dL alone does not confirm DKA. You need to obtain:

• Arterial or venous pH (DKA: pH <7.3; HHS: pH >7.3)
• Serum bicarbonate (DKA: <15 mEq/L; HHS: >15 mEq/L)
• Serum or urine ketones (DKA: positive; HHS: small or negative)
• Calculated effective serum osmolality (HHS: typically >320 mOsm/kg)
• Mental status assessment 1

At 600 mg/dL, this patient could have either condition - DKA typically presents with glucose >250 mg/dL but <600 mg/dL, while HHS characteristically shows glucose ≥600 mg/dL 1.

Which Patient Handout to Print

If DKA is Confirmed (pH <7.3, ketones present):

Print educational materials focused on:

• Sick-day management protocols emphasizing never stopping insulin
• When to check ketones (when glucose >300 mg/dL)
• Early warning signs requiring immediate medical contact
• Specific actions: supplemental short-acting insulin dosing, maintaining hydration with carbohydrate-containing fluids
• Infection prevention and fever management 1

If HHS is Confirmed (pH >7.3, minimal ketones, altered mental status):

Print materials emphasizing:

• Recognition of severe dehydration symptoms
• Importance of caregiver supervision (especially for elderly patients who cannot recognize evolving dehydration)
• Monitoring requirements during intercurrent illness
• Medications and conditions that worsen hyperglycemia 1

Key Educational Content to Include

The most effective patient education materials should be simplified, visually clear, and action-focused rather than general education 2. Recent codesign research demonstrates that patient handouts work best when they:

• Use clear, accessible language with specific behavioral actions
• Emphasize key barriers relevant to most individuals
• Include visual elements that enhance understanding
• Focus on actionable prevention steps 2

Critical Prevention Messages:

1. Never discontinue insulin - this is the most common precipitating factor, particularly in urban populations where economic barriers exist 1, 3
2. Contact healthcare provider early during any illness
3. Monitor blood glucose and ketones when glucose exceeds 300 mg/dL
4. Maintain adequate hydration with carbohydrate-containing fluids during illness
5. Record vital information: glucose levels, ketones, insulin doses, temperature, pulse, weight 1

Common Pitfall to Avoid

Do not print generic diabetes education materials for a patient at this glucose level - they need crisis-specific prevention education. The distinction between DKA and HHS matters because:

• DKA patients need ketone monitoring education
• HHS patients (often elderly) need caregiver-focused materials about recognizing dehydration
• Prevention strategies differ based on the underlying condition 1

One-third of DKA cases occur in patients without known diabetes 4, so if this is new-onset diabetes, the educational approach must include basic diabetes management alongside crisis prevention.

Implementation Note

Effective DKA prevention requires patient/family ability to accurately measure and communicate: blood glucose, ketone levels, insulin administered, temperature, respiratory rate, pulse rate, and body weight to healthcare professionals 1. Your printed handout should include specific instructions on how to document and report these parameters.

Given that DKA accounts for over $1 billion annually in U.S. hospitalization costs, with many admissions preventable through proper education 1, investing time in printing and reviewing appropriate educational materials is clinically and economically justified.