Chapter 9: Blood Glucose Monitoring
9.3 Hypoglycemia and hyperglycemia
Critical Thinking Exercises: Questions, Answers, and Sources / References
- 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 |
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| 2.2 to 3.9 mmol/L | Give 15 g of glucose in the form of:
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| ≤ 2.2 mmol/L |
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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