Monitor urine albumin to serum creatinine for renal failure. Renal failure causes creatinine >1.5 mg/dL. Microalbuminuria is the first sign of diabetic nephropathy.

Instruct patient to avoid heating pads and always to wear shoes when walking. Patients have decreased sensation in the extremities due to peripheral neuropathy.

Report BP of more than 160 mm Hg (systolic). Administer hypertensive as prescribed. Hypertension is commonly associated with diabetes. Control of BP prevents coronary artery disease, stroke, retinopathy, and nephropathy.

Teach patient how to perform home glucose monitoring. Blood glucose is monitored before meals and at bedtime. Glucose values are used to adjust insulin doses.

Administer basal and prandial insulin. Adherence to the therapeutic regimen promotes tissue perfusion. Keeping glucose in the normal range slows progression of microvascular disease.

Monitor for signs of hypoglycemia. A patient with type 2 DM who uses insulin as part of the treatment plan is at increased risk for hypoglycemia. Manifestations of hypoglycemia may vary among individuals but are consistent in the same individual. The signs are the result of both increased adrenergic activity and decreased glucose delivery to the brain, therefore, the patient may experienced tachycardia, diaphoresis, dizziness, headache, fatigue, and visual changes.

Assess the pattern of physical activity. Physical activity helps lower blood glucose levels. Regular exercise is a core part of diabetes management and reduces risk for cardiovascular complications.

Assess the patient’s current knowledge and understanding about the prescribed diet. Nonadherence to dietary guidelines can result in hyperglycemia. An individualized diet plan is recommended.

Assess feet for temperature, pulses, color, and sensation. To monitor peripheral perfusion and neuropathy.

Assess for anxiety, tremors, and slurring of speech. Treat hypoglycemia with 50% dextrose. These are signs of hypoglycemia and D50 is treatment for it.

Monitor patient’s HbA1c-glycosylated hemoglobin. This is a measure of blood glucose over the previous 2 to 3 months. A level of 6.5% to 7% is desirable.

Assess blood glucose level before meals and at bedtime. Blood glucose should be between 140 to 180 mg/dL. Non-intensive care patients should be maintained at pre-meal levels <140 mg/dL.

Assess for signs of hyperglycemia. Hyperglycemia results when there is an inadequate amount of insulin to glucose. Excess glucose in the blood creates an osmotic effect that results in increased thirst, hunger, and increased urination. The patient may also report nonspecific symptoms of fatigue and blurred vision.

Patient has a blood glucose reading of less than 180 mg/dL; fasting blood glucose levels of less than <140 mg/dL; hemoglobin A1C level <7%.

[Not applicable for risk diagnosis. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.]

The pancreas is unable to keep up with rising levels of postprandial glucose. The result is delayed insulin hyper-section and hypoglycemia.

Fasting hypoglycemia occurs as a result of excessive insulin production, decreased glucose production by the liver, hormone deficiencies and autoimmune diseases.

Reactive hypoglycemia occurs in the fed state (non-fasting), which is about 3-5 hours after meals. It is caused by an idiopathic delay in insulin secretion or a rising levels of postprandial glucose level due to rapid gastric emptying.