If your patient has already been diagnosed with diabetes, you’ll need to ask some additional questions about her regimen. Specifically, you should ask about her medication, diet, exercise, and monitoring techniques.

Insulin and other drugs used to control diabetes lower blood glucose levels, putting patients at risk for hypoglycemia. Inappropriate diet and excessive exercise can also cause hypoglycemia. Ask your patient about the frequency of her hypoglycemic episodes and any signs or symptoms. Although hypoglycemic signs and symptoms may vary from patient to patient, the most common ones include headache, tremors, difficulty concentrating, drowsiness, irritability, anxiety, weakness, cold and clammy skin, light-headness, difficulty talking, and rapid heartbeat. If left uncorrected, hypoglycemia can lead to seizures and coma. Find out what kind of treatment your patient has received for hypoglycemia and how she has responded. Also, ask her if she can identify the cause of each episode . This information will help you evaluate your patient’s compliance with her regimen and her understanding of hypoglycemia. It may also lead to a change in the regimen.

Hyperglycemia may develop when your patient encounters stress and unavoidable changes in her daily life. Find out how much she understands about hyperglycemia and its two emergency complications, DKA and HHNK syndrome. Ask her about the frequency and severity of hyperglycemia, the signs or symptoms she experiences, any treatment she has received, and any changes made in her treatment plan. Frequent treatment for hyperglycemia may mean that she isn’t complying with her treatment plan or that it’s ineffective. To help her, explore the reasons for her hyperglycemia. Also, ask her if she understands sick-day rules and urine ketone testing. Illness is a common cause of hyperglycemic emergencies.

Finally, ask your patient if she has any concerns about her treatment plan. Her answers will help you and other members of the health care team identify potential problems and redesign a treatment plan that best fits her needs.