Unstable blood Glucose

Nursing Care Plan for Diabetes Mellitus

Unstable blood Glucose related to lack of adherence to diabetes management and inadequate blood glucose monitoring as evidenced by fingerstick 450/adm.

Outcome
Blood Glucose Control (NOC) Indicators:

Client Will
Demonstrate correction of metabolic state as evidenced by fasting blood sugar (FBS) less than 120 mg/dL within 36 hours (6/30, 7 a.m.).

Nursing care plan intervention with rationale:
1. Perform fingerstick BG qid.
Rationale: Bedside analysis of blood glucose levels is a more timely method for monitoring effectiveness of therapy and provides direction for alteration of medications.

2. Administer antidiabetic medications.
Rationale: Treats underlying metabolic dysfunction, reducing hyperglycemia and promoting healing.

3. 10 units Humulin N insulin SC q AM/hs after fingerstick BG.
Rationale: Intermediate-acting preparation with onset of 2 to 4 hr, peak 4 to 10 hr, and duration 10 to 16 hr. Increases transport of glucose into cells and promotes the conversion of glucose to glycogen.

4. DiaBeta 10 mg PO bid.
Rationale: Lowers blood glucose by stimulating the release of insulin from the pancreas and increasing the sensitivity to insulin at the receptor sites.

5. Glucophage 500 mg PO daily. Note onset of side effects.
Rationale: Glucophage lowers serum glucose levels by decreasing hepatic glucose production and intestinal glucose absorption and increasing sensitivity to insulin. By using in conjunction with DiaBeta, client may be able to discontinue insulin once target dosage is achieved (e.g., 2,000 mg/day). Increase of 1 tablet per week is necessary to limit side effects of diarrhea, abdominal cramping, and vomiting, possibly leading to dehydration and prerenal azotemia.

6. Provide diet 2,400 cal—three meals/two snacks.
Rationale: Proper diet decreases glucose levels and insulin needs, prevents hyperglycemic episodes, reduces serum cholesterol levels, and promotes satiation.

7. Schedule consultation with dietitian to restructure meal plan and evaluate food choices.
Rationale: Calories are unchanged on new orders but have been redistributed to two meals and two snacks. Dietary choices (e.g., increased vitamin C) may enhance healing.