Review the onset, peak, and duration of action of the insulin your patient uses. When her insulin is at peak effect, check her for signs and symptoms of hypoglycemia. Be familiar with oral antidiabetic drugs that can cause hypoglycemia, such as sulfonylureas. Whether she uses insulin or oral antidiabetic drugs, monitor her blood glucose level before meals and at bedtime and tell her to do the same at home.Advise your patient to administer her insulin and oral antidiabetic drugs on time. Patients should eat 5 to 30 minutes after insulin administration, depending on the type of insulin. For example, a patient should eat within 5 minutes after taking Humalog or 30 minutes after taking regular insulin. If your patient leaves the hospital unit temporarily, make sure she takes her insulin and eats her meals on schedule. If a meal will be delayed, give her a snack. Also, provide betweenmeal and bedtime snacks, if needed, at the time of insulin’s peak activity.
If your patient isn’t allowed anything by mouth before a procedure, contact her physician to obtain changes in orders for her insulin and oral antidiabetic drugs.
Patient Teaching
Teach your patient and her family how to prevent, recognize, and manage hypoglycemia . Making your patient an active participant in her care will help her counter feelings of helplessness and loss of control. Enlist her family’s help and ease their fears by teaching them about hypoglycemia as well.
If your patient experiences hypoglycemia, help her identify what may have caused it. Even mild hypoglycemia will disrupt her daily routine if it occurs frequently. Anticipating hypoglycemia without understanding its causes and treatment may affect her compliance with her regimen. For example, she may be afraid to inject insulin for fear of another hypoglycemic episode.
Assess your patient for administration problems, such as administering too much insulin or too high a dose of an oral antidiabetic drug. Ask her to demonstrate how she administers insulin. Also, discuss the timing, quantity, and content of her meals as well as the extent and timing of exercise.
Encourage your patient to monitor her blood glucose level regularly and whenever she experiences hypoglycemic symptoms. Such monitoring will help her learn her threshold for hypoglycemia and recognize her typical symptoms at various glucose levels. Then when she experiences hypoglycemia, she can treat it appropriately.
Teach your patient to recheck her blood glucose level 15 minutes after taking a rapidly absorbed carbohydrate. Encourage her to keep rapidly absorbed carbohydrates, such as hard candies or glucose tablets, available at home and to carry them with her when she goes out. Also, advise the patient to carry a nonperishable snack, such as a package of peanut butter crackÂers, to eat in case a meal isn’t available within 1 hour after a hyperglycemic episode.
Identify a family member or friend who can help your patient if she develops hypoglycemia. Teach this person how to prepare and administer glucagon if hypoglycemia hinders the patient’s ability to swallow. Warn the patient that nausea is a common adverse effect of glucagon; she may need to take small sips of a carbonated, uncaffeinated soft drink until her nausea subsides.
For an elderly patient who lives alone, identify someone who’s willing to learn about hypoglycemia and check on her regularly. Encourage your elderly patient to contact the physician if she experiences frequent hypoglycemia. Also, instruct her to notify the physician if her blood glucose level falls below the target level more often than prescribed guidelines permit. The patient’s drug dosage may need to be adjusted.
Advise your patient to buy a medical alert bracelet or necklace that describes her condition and lists the physician’s phone number-especially if she’s prone to severe hypoglycemia.
When your patient leaves the hospital, give her written discharge instructions about diet, exercise, drugs, blood glucose monitoring, and signs, symptoms, and treatment of hypoglycemia.