The nurse prepares to teach four clients about diabetes mellitus. Which client has the greatest need for instructions? Reference Range: Glycosylated hemoglobin A1C (HbA1C) [good glycemic control: less than 10%] Random blood glucose [less than or equal to 200 mg/dL (less than 11.1 mmol/L] Postprandial glucose (1-hour gestational diabetes) [less than 140 mg/dL (less than 7.8 mmol/L)] Fasting blood glucose [70 to 110 mg/dL (less than 6.1 mmol/L)]

A. A child with asthma, who takes prednisone and has a fasting serum glucose of 180 mg/dL (10 mmol/L): This client’s fasting glucose is well above the normal range. Prednisone can increase blood glucose levels, placing the child at risk for hyperglycemia. This indicates a need for urgent education on blood glucose management while on steroids. B. An adolescent male who has type 1 diabetes and a random glucose at 120 mg/dL (6.7 mmol/L): This blood glucose level is within normal limits for random testing. No immediate need for change in diabetic teaching is evident based on this value. C. A female who has gestational diabetes and has a 1-hour postprandial glucose at 140 mg/dL (7.8 mmol/L): Her result meets the upper limit range for gestational diabetes. While she requires ongoing monitoring, her values do not indicate a need for urgent intervention. D. An adult who has type 2 diabetes and has a glycosylated hemoglobin (Hb A1C) at 10%: Although this indicates poor long-term control, it reflects a chronic issue. The child with an acutely elevated fasting glucose and corticosteroid use is at greater immediate risk and thus has higher priority for education.