glucose
Abnormal Glucose
What is the target range for this patient?
This should be agreed with GP/ diabetes team
Standard target 5-12 mmol/L - Conservative target 6-15 mmol/L - If frail: 6-20 mmol/L
This should be agreed with GP/ diabetes team
Standard target 5-12 mmol/L - Conservative target 6-15 mmol/L - If frail: 6-20 mmol/L
Hyperglycaemia
Glucose more than target or ≥15mmol/L Twice within 24h.
Type 1
- Check for ketones, if 0.6-1.5, recheck Glu & ketones in 2/24
- 1.5mmol/L, escalate to CHS diabetic nurse specialist for urgent advice
Type 2
- Check pre-meal Glu for 1/52
- contact GP/diabetes team for a diabetes consult and review of oral med's +/- insulin
Identify and record any precipitating factor, think of potential causes/risks
- Nutritional intake
- Infection/ deteriorating health
- Steroids
- Alcohol
- Adherence to medication/insulin
- Poor insulin injection technique
- Adequate injection site (abdo, thighs,any lumps?)
Can you correct any of these factors to prevent escalation of hyperglycaemia?
Red Flags
- Sepsis
- reduced level of consciousness
- Signs of dehydration
Hypoglycaemia
Contact GP/ diabetes team to reduce Insulin +/- oral diabetes meds.
Glucose <4mmol/L (<5mmol/L if frail) more than twice within a week.
Patient alert
- Give oral glucose/any sugary drink followed by carbohydrates meal.
- Recheck glucose after 15 minutes</card>
Unconscious patient or Glu<3
*Call 999
*Recheck glucose after 15 minutes
Consider & record any potential risks, causes
- Poor nutrition/ability to access food
- New/worsening Cognitive impairment
- Medication/insulin overdose
- Deteriorating health
- End of life
- Renal failure/liver failure
Can you correct these factors and prevent further low Glu?
Red Flags
- no nutritional intake for >24/24
- Sepsis
- Reduced level of consciousness
- Confusion aggression