If acute illness or infection isn’t the cause of your patient’s hyperglycemia, it may be her diet, exercise level, or drugs. Or she may not be hyperglycemic, but may appear to be because she uses an incorrect technique for self-monitoring or an inaccurate glucose meter.Review your patient’s recent dietary intake. Did she exceed her allocated food intake? Ask her about mealtimes and eating habits, especially if her blood glucose level is consistently elevated at a particular time of day.

Ask your patient if she has changed her exercise program. A decrease in exercise or a change in the type of exercise can cause her blood glucose level to fluctuate.

Review your patient’s drugs. Have any dosages been changed recently? Has she stopped taking any drugs? Is she taking a drug that raises the blood glucose level?

If your patient injects insulin, find out if she uses insulin that’s beyond its expiration date. Ask her to demonstrate her administration technique. Does she gently roll cloudy insulin? Is she drawing up the prescribed amount? Do you see large air bubbles in the syringe that might cause her to inject a dose that’s smaller than prescribed?

Examine your patient’s glucose meter. Has it been coded correctly for the test strips she uses? If not, glucose values may be inaccurate. Ask her to demonstrate her blood testing technique; improper technique can affect test results. Review her glucose test records. Look for patterns that indicate the need to alter her drug therapy.