Chapter 9: Blood Glucose Monitoring

9.3 Hypoglycemia and hyperglycemia

Critical Thinking Exercises: Questions, Answers, and Sources / References

  1. At 0930 hours, your diabetic patient complains of feeling faint. You check his blood sugar and get a reading of 2.8 mmol/L. What actions will you take?

Answer: the nurse should follow the agency’s protocol for treating hypoglycemia. Below is one such example copied from Anderson R. (2018). Clinical Procedures for Safer Patient Care: Thompson Rivers University Edition   https://pressbooks.bccampus.ca/clinicalproceduresforsaferpatientcaretrubscn/chapter/9-3-hypoglycemia-and-hyperglycemia/

Capillary Blood Gas (CBG) Able to Swallow Patient Is Not Able to Swallow but Has IV Access Patient Is Able to Swallow  but Has No IV Access
≥ 4 mmol/L
  • No treatment necessary
  • No treatment necessary
  • No treatment necessary
2.2 to 3.9 mmol/L Give 15 g of glucose in the form of:

  • 3 to 5 dextrose/glucose tabs (check the label) (best choice), OR
  • 175 ml of juice or soft drink (containing sugar), OR
  • 1 tablespoon of honey, OR
  • 3 tablespoons of table sugar dissolved in water

 

  • Note: Milk, orange juice, and glucose gels increase blood glucose (BG) levels more slowly and are not the best choice unless the above alternatives are not available.
  • Repeat CBG every 15 to 20 minutes and repeat above if BG remains below 4 mmol/L.
  • Once BG reaches 4 mmol/L, give patient 6 crackers and 2 tablespoons of peanut butter. If meal is less than 30 minutes away, omit snack and give patient meal when it is available.
  • Notify physician.

 

  • Give 10 to 25 g (20 to 50 ml) of D50W (dextrose 50% in water) of glucose intravenously over 1 to 3 minutes, OR as per agency policy.

 

  • Repeat CBG every 15 to 20 minutes until 4 mmol/L.

 

  • Continue with BG readings every 30 minutes for 2 hours.
  • Notify physician.

 

  • Give glucagon 1 mg subcutaneously (SC) or intramuscularly (IM).

 

  • Position patient on side.

 

  • Repeat CBG every 15 to 20 minutes. Give second dose of glucagon 1 mg SC or IM if BG remains below 4 mmol/L.
≤ 2.2 mmol/L
  • Call lab for STAT BG level.
  • Continue as above.
  • Call lab for STAT BG level.
  • Continue as above.
  • Call lab for STAT BG level.
  • Continue as above.

Sources:

Canadian Diabetes Association. (2013). Canadian diabetes association clinical practice guidelines expert committee. Clinical practice guidelines for the prevention and management of diabetes in Canada. Canadian Journal of Diabetes, 37(1), S1-S212.

Pardalis, D. (2005). Diabetes: Treatment of hyper- and hypoglycemia. Tech Talk CE.  http://www.canadianhealthcarenetwork.ca/files/2009/10/TTCE_Sept05_Eng.pdf.

Rowe, B. H., Singh, M., Villa-Roel, C., Leiter, L. A., Hramiak, I., Edmonds, M. L., … Campbell, S. (2015). Acute management and outcomes of patients with diabetes mellitus presenting to Canadian emergency departments with hypoglycemia. Canadian Journal of Diabetes, 39(1), 55-64. doi:10.1016/j.jcjd.2014.04.001.

Vancouver Coastal Health (VCH). (2009). Hypoglycemia algorithm. Vancouver: Vancouver Coastal Health.

 

2. What blood glucose level range do you expect immediately post-operatively from your patient who has type 2 diabetes? Why?

Answer: If the patient has not taken any hypoglycemic medications and has remained NPO for surgery, then immediately post op the patient may experience hyperglycemia simply because of the body’s stress response (conversion of glycogen to glucose) and the inability to move the glucose from the blood stream to the cells.

 

Besides elevated serum glucose, the common symptoms of hyperglycemia are:

  • Increased urination/output (polyuria)
  • Excessive thirst (polydipsia)
  • Increased appetite (polyphagia), followed by lack of appetite
  • Weakness, fatigue
  • Headache

Sources:

Canadian Diabetes Association. (2013). Canadian diabetes association clinical practice guidelines expert committee. Clinical practice guidelines for the prevention and management of diabetes in Canada. Can J diabetes, 37(suppl 1):S1-S212.

Pardalis, D. (2005). Diabetes: Treatment of hyper- and hypoglycemia. Retrieved on Nov 14, 2015, from Tech Talk: The national continuing education program for pharmacy technicians. http://www.canadianhealthcarenetwork.ca/files/2009/10/TTCE_Sept05_Eng.pdf

Rowe, B. H., Singh, M., Villa-Roel, C., Leiter, L. A., Hramiak, I., Edmonds, M. L., & … Campbell, S. (2015). Acute management and outcomes of patients with diabetes mellitus presenting to Canadian emergency departments with hypoglycemia. Canadian Journal Of Diabetes, 39(1), 55-64. doi:10.1016/j.jcjd.2014.04.001

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