Patient Education for Insulin Use and Signs of DKA in Severe Hyperglycemia (A1C >15%)
For patients with severe hyperglycemia (A1C >15%), comprehensive education on insulin management and recognizing diabetic ketoacidosis (DKA) is essential to prevent life-threatening complications and improve outcomes.
Insulin Education
Administration Technique
- Teach proper subcutaneous injection technique, including site rotation to prevent lipodystrophy 1
- Instruct patients to always check insulin labels before each injection to avoid medication errors 2
- Emphasize that insulin pens and needles should never be shared with others due to infection risk 2
Insulin Regimen for Severe Hyperglycemia
- Explain that with A1C >15%, a combination of basal and mealtime insulin will likely be needed 3
- Teach that basal insulin (like detemir) provides background insulin coverage while rapid-acting insulin (like aspart) covers meals 3
- Instruct on proper timing: rapid-acting insulin should be taken 5-10 minutes before meals 2
- Emphasize that insulin should never be stopped abruptly, even when sick or not eating 3
Blood Glucose Monitoring
- Instruct on frequent self-monitoring of blood glucose (at least 4 times daily) 3
- Teach target blood glucose ranges and when to contact healthcare providers 2
- Consider continuous glucose monitoring if available to help prevent DKA recurrence 3
Signs and Symptoms of DKA
Early Warning Signs
- Educate on polyuria (excessive urination), polydipsia (excessive thirst), and unexplained weight loss as early warning signs 4
- Teach recognition of fatigue, nausea, vomiting, and abdominal pain as potential DKA symptoms 4
- Explain that Kussmaul respiration (deep, rapid breathing) indicates developing acidosis 3
When to Check for Ketones
- Instruct patients to check urine or blood ketones when:
When to Seek Medical Attention
- Teach patients to seek immediate medical care if:
Sick Day Management
Insulin Adjustments During Illness
- Emphasize that insulin should NEVER be stopped during illness, even when not eating 3
- Teach supplemental rapid-acting insulin dosing during illness based on blood glucose readings 3
- Instruct on maintaining basal insulin doses during illness, with possible adjustments under provider guidance 1
Hydration and Nutrition
- Educate on the importance of maintaining hydration with non-caloric fluids during illness 3, 5
- Teach consumption of easily digestible carbohydrates if unable to eat regular meals 6
- Instruct on monitoring fluid intake and output during illness 5
Prevention Strategies
Risk Factors for DKA
- Educate on common DKA triggers: infection, missed insulin doses, emotional stress, and trauma 7
- Identify patient-specific risk factors from Table 6.9, including younger age, prior DKA history, and presence of other health conditions 3
- Teach recognition of situations requiring more frequent monitoring (illness, stress, travel) 2
Emergency Preparedness
- Provide a written sick day protocol with specific instructions for insulin dosing 3
- Ensure patient has ketone testing supplies at home 3
- Create an emergency contact plan with healthcare provider phone numbers 7
Common Pitfalls to Avoid
- Warn against stopping insulin during illness, which is a common cause of DKA 3, 7
- Caution about delayed recognition of symptoms, especially in patients with reduced awareness 2
- Emphasize the dangers of inadequate hydration during hyperglycemic episodes 5
- Explain that even with insulin pumps or newer medications, DKA can still occur if insulin delivery is interrupted 8
By providing this comprehensive education, patients with severe hyperglycemia can better manage their condition and potentially prevent life-threatening complications like DKA.