What are the nursing assessments required for a patient with type 1 diabetes (T1D) who develops hyperglycemia?

From the Guidelines

Nursing assessments for a hyperglycemic patient with Type 1 diabetes should include frequent blood glucose monitoring, typically every 1-2 hours until stabilized, using a glucometer or continuous glucose monitoring system, as well as vital signs assessment, neurological assessment, laboratory tests, and fluid status assessment. The most recent and highest quality study, 1, provides guidance on the management of diabetes and hyperglycemia in the hospital, emphasizing the importance of frequent blood glucose monitoring and adjusting insulin regimens accordingly. Key assessments include:

• Frequent blood glucose monitoring to detect hyperglycemia and potential diabetic ketoacidosis (DKA)
• Vital signs assessment, focusing on heart rate, blood pressure, respiratory rate, and temperature
• Neurological assessment to identify altered mental status, confusion, or lethargy
• Laboratory tests, including blood glucose levels, serum ketones, electrolytes, blood gases, and urinalysis for glucose and ketones
• Fluid status assessment to detect signs of dehydration Additionally, nurses should evaluate the patient's insulin administration history, recent dietary intake, medication adherence, and potential illness or stress triggers, as these factors can contribute to hyperglycemia in patients with Type 1 diabetes, as discussed in 1 and 1. The importance of frequent blood glucose monitoring is also highlighted in 1, which recommends testing blood glucose levels at least three times daily, as well as before and after exercising, before driving, and when uncertain if blood glucose is at an appropriate level. By prioritizing these assessments, nurses can provide timely and effective care to hyperglycemic patients with Type 1 diabetes, reducing the risk of complications and improving outcomes.

From the FDA Drug Label

Hyperglycemia (High Blood Sugar) and Diabetic Ketoacidosis (DKA) Hyperglycemia (too much glucose in the blood) may develop if your body has too little insulin Hyperglycemia can be brought about by any of the following: Omitting your insulin or taking less than your doctor has prescribed. Eating significantly more than your meal plan suggests. Developing a fever, infection, or other significant stressful situation. In patients with type 1 or insulin-dependent diabetes, prolonged hyperglycemia can result in DKA (a life-threatening emergency)

The nursing assessments required for a patient with type 1 diabetes (T1D) who develops hyperglycemia include:

• Monitoring blood glucose levels frequently
• Assessing for signs and symptoms of hyperglycemia and diabetic ketoacidosis (DKA), such as:
  • Polydipsia
  • Polyuria
  • Loss of appetite
  • Fatigue
  • Dry skin
  • Abdominal pain
  • Nausea and vomiting
  • Compensatory tachypnea
• Evaluating the patient's insulin administration and meal plan to identify potential causes of hyperglycemia
• Monitoring potassium levels closely when intravenously administered insulin is used 2, 2

From the Research

Nursing Assessments for Hyperglycemia in Type 1 Diabetes

The following nursing assessments are required for a patient with type 1 diabetes (T1D) who develops hyperglycemia:

• Monitor blood glucose levels regularly to assess the severity of hyperglycemia 3, 4
• Assess for signs and symptoms of diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS), such as dehydration, metabolic acidosis, and ketone body formation 3, 5
• Evaluate the patient's insulin therapy and adjust as needed to correct hyperglycemia 3, 4
• Monitor for precipitating causes of hyperglycemia, such as infection or insulin omission 5
• Assess the patient's overall health status, including age, comorbidities, and presence of coma or hypotension, which can worsen the prognosis of hyperglycemic crises 5
• Provide patient education on home glucose and ketone monitoring to prevent hospital admissions due to DKA and HHS 5, 6

Prevention and Management of Hyperglycaemic Crises

Nurses play a crucial role in preventing and managing hyperglycaemic crises in patients with T1D:

• Be aware of the causes and clinical manifestations of hyperglycaemic crises, including DKA and HHS 6
• Follow national guidelines for the management of patients with hyperglycaemic crises 6
• Implement nursing interventions to prevent hypoglycaemic events, such as adjusting insulin therapy and providing patient education on glucose monitoring and management 7