{
  "name": "Unstable Blood Glucose",
  "slug": "unstable-blood-glucose",
  "url": "https://nursingplex.com/care-plans/unstable-blood-glucose",
  "category": "Endocrine & Metabolic",
  "summary": "Swings between hyper- and hypoglycemia; sick-day rules and rapid treatment protocols.",
  "nursing_diagnoses": [
    "Risk for unstable blood glucose",
    "Deficient knowledge",
    "Risk for injury"
  ],
  "overview": [
    "Risk for unstable blood glucose describes vulnerability to swings above or below the normal range. Hyperglycemia develops from insufficient insulin, illness, steroids, infection or excess carbohydrate; hypoglycemia from too much insulin or sulfonylurea, missed meals, alcohol, exercise or renal impairment.",
    "Hypoglycemia is the more immediate danger: below roughly 70 mg/dL patients become shaky, sweaty and confused, and below 40 they risk seizure and coma. Patients with long-standing diabetes or on beta blockers may have hypoglycemia unawareness and lose these warning signs.",
    "Nursing care builds a predictable structure — consistent monitoring, meal timing, medication administration and sick-day rules — and teaches the patient to recognize and treat excursions early."
  ],
  "key_facts": [
    {
      "label": "15-15 rule",
      "text": "For conscious hypoglycemia give 15 g fast carbohydrate, recheck in 15 minutes, repeat if still low, then give a protein-containing snack."
    },
    {
      "label": "Unconscious patient",
      "text": "Give IM/SC glucagon or IV dextrose 50%; never give oral carbohydrate."
    },
    {
      "label": "Sick-day rule",
      "text": "Never omit insulin during illness; check glucose and ketones more often and maintain fluids."
    },
    {
      "label": "Somogyi vs dawn",
      "text": "Check 2–3 a.m. glucose: low suggests rebound (Somogyi), normal-to-high suggests dawn phenomenon."
    }
  ],
  "nursing_priorities": [
    "Monitor glucose at appropriate intervals for the therapy in use.",
    "Prevent and rapidly treat hypoglycemia.",
    "Coordinate insulin, meals and activity.",
    "Detect and treat hyperglycemia and ketosis.",
    "Teach self-management and sick-day rules."
  ],
  "assessment": {
    "subjective": [
      "Reports of shakiness, sweating, hunger, palpitations or anxiety",
      "Reports of thirst, frequent urination, blurred vision or fatigue",
      "History of missed meals, alcohol use or unusual exercise",
      "Reports of not feeling low blood sugars anymore"
    ],
    "objective": [
      "Capillary glucose values outside target range",
      "Diaphoresis, tremor, tachycardia or altered mental status",
      "Kussmaul respirations, fruity breath or ketonuria in severe hyperglycemia",
      "A1c indicating overall control",
      "Medication, meal and activity timing discrepancies"
    ],
    "related_factors": [
      "Insufficient or excessive insulin or oral agents",
      "Inconsistent carbohydrate intake or meal timing",
      "Illness, infection, surgery or corticosteroid therapy",
      "Exercise without adjustment; alcohol intake",
      "Renal or hepatic impairment altering drug clearance"
    ]
  },
  "goals": [
    "The client will maintain glucose within the individualized target range.",
    "The client will recognize and self-treat hypoglycemia correctly.",
    "The client will demonstrate accurate glucose monitoring and insulin technique.",
    "The client will state sick-day management rules."
  ],
  "interventions": [
    {
      "title": "Monitor and respond",
      "points": [
        "Check glucose before meals and at bedtime, or per protocol for the therapy used.",
        "Treat hypoglycemia immediately with the 15-15 rule and recheck; document and analyze the cause.",
        "Give insulin according to type, onset and peak, coordinating with meal delivery.",
        "Check ketones when glucose exceeds 240 mg/dL or during illness."
      ]
    },
    {
      "title": "Coordinate therapy",
      "points": [
        "Ensure meal trays arrive before rapid-acting insulin takes effect.",
        "Adjust monitoring around exercise, procedures and NPO periods per protocol.",
        "Review medications that alter glucose, especially corticosteroids and beta blockers.",
        "Keep fast-acting carbohydrate and glucagon readily available."
      ]
    },
    {
      "title": "Build self-management",
      "points": [
        "Observe the patient's own monitoring and injection technique and correct errors.",
        "Teach site rotation and inspection for lipohypertrophy.",
        "Review carbohydrate counting and consistent meal timing with the dietitian.",
        "Provide written sick-day rules and emergency contact information."
      ]
    }
  ],
  "patient_teaching": [
    "Always carry fast-acting carbohydrate and wear medical identification.",
    "Teach family or coworkers to use glucagon.",
    "Explain that insulin is never stopped during illness even if not eating normally.",
    "Encourage regular A1c, foot and eye examinations."
  ]
}