Diabetes Mellitus Nursing Diagnosis and Care Plan: A Comprehensive Guide

Diabetes Mellitus (DM) is a pervasive, chronic metabolic condition characterized by the body’s impaired ability to metabolize carbohydrates, fats, and proteins effectively due to issues with insulin production or utilization. This dysfunction leads to hyperglycemia, or elevated blood glucose levels, which can have significant health consequences if not properly managed. Understanding diabetes, particularly from a nursing perspective, is crucial for providing optimal patient care. This article delves into the essential aspects of diabetes mellitus, focusing on nursing diagnosis and care plans to equip healthcare professionals with the knowledge to deliver effective and patient-centered care.

Types of Diabetes Mellitus

Diabetes mellitus is not a single disease but rather a group of metabolic disorders. The primary types of diabetes include:

Type 1 Diabetes Mellitus: Characterized by an autoimmune reaction where the body’s immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. This results in an absolute deficiency of insulin. While the exact trigger is not fully understood, genetic predisposition and environmental factors such as viral infections are thought to play a significant role. Type 1 diabetes typically has a rapid onset and often develops in childhood or adolescence, though it can occur at any age.

Type 2 Diabetes Mellitus: The most common form of diabetes, type 2 develops gradually over time. It is marked by insulin resistance, where the body’s cells do not respond effectively to insulin, and eventually, insufficient insulin production from the pancreas. Lifestyle factors, including obesity, physical inactivity, and unhealthy diets, are major contributors to the development of type 2 diabetes. Genetic factors also increase susceptibility. It is more prevalent in adults, particularly those over 40, but is increasingly being diagnosed in younger populations due to rising rates of childhood obesity.

Gestational Diabetes Mellitus (GDM): This type of diabetes develops during pregnancy in women who have not previously been diagnosed with diabetes. Hormonal changes during pregnancy can lead to insulin resistance. GDM typically resolves after childbirth, but it significantly increases the mother’s risk of developing type 2 diabetes later in life and can also pose risks to the baby’s health.

Prediabetes: A precursor to type 2 diabetes, prediabetes is a condition where blood glucose levels are higher than normal but not yet high enough to be classified as type 2 diabetes. Specifically, prediabetes is diagnosed with a fasting blood glucose level between 100-125 mg/dL. Prediabetes often presents no clear symptoms, but it is a critical stage where lifestyle interventions can effectively prevent or delay the onset of type 2 diabetes.

Blood Glucose Imbalances: Hypoglycemia and Hyperglycemia

Maintaining stable blood glucose levels is a delicate balance. Both excessively low (hypoglycemia) and excessively high (hyperglycemia) blood glucose levels can pose immediate and long-term health risks for individuals with diabetes.

Hypoglycemia: Low Blood Glucose

Hypoglycemia, clinically defined as blood glucose levels below 70 mg/dL, is a potentially dangerous condition requiring prompt intervention. When blood glucose drops too low, the brain and other organs are deprived of their primary energy source, leading to a range of symptoms.

Causes of Hypoglycemia

Several factors can contribute to hypoglycemia in individuals with diabetes, including:

• Excessive Insulin or Oral Hypoglycemic Medications: Taking too much insulin or certain oral diabetes medications can drive blood glucose levels too low.
• Missed or Delayed Meals: Insufficient carbohydrate intake or prolonged periods without eating can deplete glucose stores and lead to hypoglycemia, especially in individuals taking insulin or insulin secretagogues.
• Intense Physical Activity: Exercise increases glucose utilization. Without adequate carbohydrate intake adjustments or insulin dose reductions, strenuous physical activity can cause hypoglycemia.
• Alcohol Consumption: Alcohol can interfere with the liver’s ability to release glucose into the bloodstream, particularly when consumed on an empty stomach, increasing the risk of hypoglycemia.
• Medication Timing and Dosage Errors: Inconsistencies in the timing or dosage of insulin or oral diabetes medications can disrupt blood glucose balance.
• Other Factors: Less common factors include hormonal changes (puberty, menstruation), hot and humid weather (which can affect insulin absorption), and certain medical conditions.

Hyperglycemia: High Blood Glucose

Hyperglycemia, defined as fasting blood glucose levels greater than 125 mg/dL or a blood glucose level of 180 mg/dL or higher one to two hours after eating, occurs when there is insufficient insulin in the body or when the body cannot use insulin effectively. Persistent hyperglycemia, if untreated, can lead to both acute and chronic complications.

Causes of Hyperglycemia

Hyperglycemia can be triggered by a variety of factors, often related to diabetes management and lifestyle:

• Dietary Indiscretions: Consuming excessive amounts of carbohydrates, particularly simple sugars, can lead to a rapid rise in blood glucose levels.
• Physical Inactivity: Lack of physical activity reduces insulin sensitivity and glucose utilization by muscles, contributing to hyperglycemia.
• Illness and Infection: During periods of illness or infection, the body releases stress hormones, which can counteract insulin and elevate blood glucose levels.
• Stress: Both physical and emotional stress can trigger hormonal responses that lead to increased glucose production by the liver and insulin resistance.
• Steroid Medications: Corticosteroids and other steroid medications can increase blood glucose levels as a side effect.
• Inadequate Diabetes Medication Management: Missing doses of insulin or oral diabetes medications, or improper medication administration, can result in hyperglycemia.

Nursing Assessment for Diabetes Mellitus

A comprehensive nursing assessment is the cornerstone of effective diabetes care. It involves gathering subjective and objective data to understand the patient’s condition, identify potential problems, and tailor individualized care plans.

Review of Health History (Subjective Data)

Gathering subjective data through patient interviews is crucial for understanding their experience with diabetes. Key areas to explore include:

1. General Symptoms: Inquire about symptoms associated with both hypoglycemia and hyperglycemia:

• Hypoglycemia Symptoms: Palpitations, tremors, sweating, anxiety, nervousness, confusion, dizziness, and hunger are common indicators of low blood glucose.
• Hyperglycemia Symptoms: Polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), blurred vision, paresthesia (burning, tingling, or numbness in extremities), fatigue, and headaches are classic signs of high blood glucose.
• Gestational Diabetes Symptoms: Women with GDM may be asymptomatic. When symptoms occur, they often mirror hyperglycemia: increased urination, thirst, hunger, blurred vision, nausea, and vomiting.

2. Duration of Diabetes and Treatment History: Determine how long the patient has had diabetes and what treatments they are currently receiving or have used in the past. The duration of diabetes and the level of glucose control are directly linked to the risk of long-term complications.

3. Age at Diagnosis: Understanding the age of onset can provide clues about the type of diabetes. Type 1 diabetes often presents in childhood or adolescence, while type 2 is more common in adults over 40.

4. Risk Factor Assessment: Evaluate both non-modifiable and modifiable risk factors for diabetes:

• Non-Modifiable Risk Factors:
  • Family History: A family history of diabetes significantly increases risk. Specific genetic mutations are associated with MODY (maturity-onset diabetes of the young) and neonatal diabetes.
  • Race/Ethnicity: Certain racial and ethnic groups, including Black, Hispanic, American Indian, and Asian Americans, have a higher prevalence of type 2 diabetes.
  • Age: The risk of prediabetes and type 2 diabetes increases with age.
  • Autoimmune Diseases: Autoimmune conditions can lead to type 1 diabetes (through destruction of beta cells) and LADA (latent autoimmune diabetes in adults).
  • Hormonal Imbalances: Conditions causing hormonal imbalances can contribute to insulin resistance and gestational or type 2 diabetes.
• Modifiable Risk Factors:
  • Obesity and Unhealthy Diet: Excess weight, particularly abdominal obesity, and diets high in fat, calories, and cholesterol increase the risk of insulin resistance and diabetes.
  • Smoking: Smoking significantly elevates the risk of type 2 diabetes and complicates diabetes management.
  • Excessive Alcohol Consumption: Heavy alcohol use can reduce insulin sensitivity and contribute to type 2 diabetes.
  • Sedentary Lifestyle: Physical inactivity increases insulin resistance, raising the risk of prediabetes and type 2 diabetes.
  • Chronic Conditions: Conditions like hypertension and hyperlipidemia are associated with an increased risk of diabetes and its complications.

5. History of Yeast Infections: Frequent yeast infections, particularly in women, can be a sign of undiagnosed or poorly controlled diabetes. High blood glucose levels create an environment conducive to yeast overgrowth.

6. Presence of Diabetes-Related Complications: Assess for existing complications, as diabetes can affect multiple organ systems:

• Cardiovascular Disease (CVD): Inquire about symptoms of CVD, such as chest pain, shortness of breath, and leg pain. Diabetes increases the risk of hypertension, hyperlipidemia, coronary artery disease, angina, myocardial infarction, and stroke.
• Neuropathy: Assess for nerve damage symptoms, including tingling, numbness, burning pain in extremities, balance problems, and reduced sensation.
• Renal Disease (Nephropathy): Inquire about changes in urine output, edema, and fatigue, which may indicate kidney damage.
• Retinopathy: Ask about vision changes, blurred vision, or difficulty seeing at night, which can be signs of diabetic retinopathy.
• Foot Damage: Assess for foot pain, numbness, ulcers, slow-healing wounds, and history of foot infections.
• Depression: Screen for symptoms of depression, as diabetes management can be emotionally challenging, and depression can negatively impact self-care and glucose control.

7. Blood Glucose Monitoring Records: Review the patient’s blood glucose logs from home monitoring devices to identify patterns of hypo- and hyperglycemia and assess overall glucose control.

Physical Assessment (Objective Data)

Objective data is obtained through physical examination and clinical assessments. In patients with well-managed diabetes, physical findings may be minimal.

1. Vital Signs:

• Blood Pressure and Heart Rate: Monitor for hypertension, common in diabetes. Assess for orthostatic hypotension, which can indicate autonomic neuropathy. Note tachycardia, which can be a compensatory mechanism in decreased cardiac output.
• Respiratory Rate: Observe for Kussmaul respirations (deep, rapid breathing), a sign of diabetic ketoacidosis (DKA).

2. Peripheral Pulses: Palpate and document dorsalis pedis and posterior tibialis pulses to assess for peripheral vascular disease, a common complication of diabetes.

3. Foot Assessment: Perform a thorough foot exam, especially in patients with neuropathy or foot ulcers. Assess:

• Sensory Neuropathy: Use the Semmes-Weinstein monofilament test, reflex testing, and vibration perception tests to evaluate protective sensation.
• Skin Integrity: Inspect for ulcers, blisters, infections, calluses, and areas of redness.
• Foot Structure: Note any deformities, such as hammer toes or bunions.

4. Weight Assessment:

• Weight Loss (Type 1 DM): Unexplained weight loss can occur in type 1 diabetes due to glycosuria and dehydration.
• Weight Gain (Type 2 DM): Assess for overweight or obesity, as these are major risk factors for type 2 diabetes and can complicate glucose management.

Diagnostic Procedures

Diagnostic procedures are essential for confirming diabetes, classifying its type, and monitoring disease progression and complications.

1. Blood Glucose Testing: Blood glucose levels are the primary diagnostic criteria for diabetes.

• Type 1 DM Diagnostic Criteria:
  • Fasting Plasma Glucose (FPG) ≥ 126 mg/dL (7.0 mmol/L)
  • Random Plasma Glucose ≥ 200 mg/dL (11.1 mmol/L) with classic symptoms of hyperglycemia
  • Hemoglobin A1c (HbA1c) ≥ 6.5% (48 mmol/mol)
• Type 2 DM Diagnostic Criteria: Similar to type 1, using FPG and HbA1c testing. Oral glucose tolerance test (OGTT) may also be used.
• Prediabetes Diagnostic Criteria:
  • Fasting Blood Sugar (FBS) 100 to 125 mg/dL (5.6 to 6.9 mmol/L)
  • 2-hour post-OGTT glucose level of 140 to 200 mg/dL (7.8 to 11.1 mmol/L)
• Gestational Diabetes Screening:
  • Screening between 24-28 weeks of gestation.
  • 1-hour glucose challenge test (GCT); if ≥ 140 mg/dL, proceed to 3-hour OGTT for confirmation.

2. Other Laboratory Tests:

• Urine Albumin: To detect early diabetic nephropathy, especially in type 1 DM.
• Serum Lipid Profile: To assess cardiovascular risk; recommended at diagnosis and periodically thereafter.
• Thyroid Function Tests: Annual testing for hypothyroidism is advised due to increased prevalence in diabetes.

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Alt Text: Person using a blood glucose meter to check blood sugar levels, demonstrating home glucose monitoring for diabetes management.

Nursing Interventions for Diabetes Mellitus

Nursing interventions are crucial for managing diabetes, preventing complications, and empowering patients to take control of their health. These interventions span glycemic control, complication prevention, and patient education.

Glycemic Control Interventions

Effective glycemic control is the primary goal in diabetes management. Nursing interventions focus on achieving and maintaining target blood glucose levels.

1. Promote Patient Adherence: Emphasize the importance of adherence to the diabetes management plan, including medication regimens, dietary recommendations, exercise plans, and follow-up appointments. Motivational interviewing and shared decision-making can enhance patient engagement.

2. Diabetes Education: Provide comprehensive diabetes education covering:

• Disease process of diabetes
• Blood glucose monitoring techniques and interpretation of results
• Medication management (insulin and/or oral agents)
• Dietary management (carbohydrate counting, meal planning)
• Exercise recommendations
• Hypoglycemia and hyperglycemia recognition and treatment
• Foot care
• Sick day management
• Importance of regular follow-up care

Referral to a certified diabetes care and education specialist (CDCES) can provide in-depth, individualized education.

3. Home Glucose Monitoring Education: Teach patients how to use a home glucose monitoring device accurately, including proper technique, frequency of testing, and recording results. Explain the target blood glucose ranges and how to respond to out-of-range values.

4. Maintain Target Glucose Levels: Work collaboratively with the healthcare team and patient to achieve and maintain individualized glycemic targets, typically an HbA1c below 7% and pre-meal blood glucose levels of 90-130 mg/dL.

5. Differentiate Type 1 and Type 2 DM Treatment: Explain the differences in treatment approaches for type 1 and type 2 diabetes. Type 1 diabetes requires insulin therapy for survival, while type 2 diabetes management often begins with lifestyle modifications and may progress to oral medications or insulin.

6. Insulin Administration Education: For patients requiring insulin, provide thorough education on:

• Types of insulin (rapid-acting, short-acting, intermediate-acting, long-acting, premixed)
• Insulin injection technique (sites, rotation, subcutaneous administration)
• Insulin storage and handling
• Drawing up insulin from vials and using insulin pens
• Dosage adjustments based on blood glucose levels, meals, and activity
• Recognition and management of insulin-related hypoglycemia

7. Insulin Pump Management: For patients using insulin pumps, provide education on:

• Pump operation and settings
• Insertion site care
• Insulin reservoir changes
• Troubleshooting pump alarms and malfunctions
• Continuous glucose monitoring (CGM) integration (if applicable)

8. Closed-Loop Insulin Delivery Systems: Explain the concept of closed-loop systems (artificial pancreas), which automatically adjust insulin delivery based on CGM readings. Provide education on system components, operation, and monitoring.

9. Oral Diabetes Medication Education: For patients with type 2 diabetes, prediabetes, or gestational diabetes, educate on oral diabetes medications, including:

• Names, actions, dosages, and side effects of prescribed medications
• Timing of medication administration in relation to meals
• Importance of adherence
• Potential interactions with other medications
• Management of potential side effects (e.g., hypoglycemia, gastrointestinal upset)

Types of oral diabetes medications include: alpha-glucosidase inhibitors, biguanides (metformin), bile acid sequestrants, dopamine-2 agonists, DPP-4 inhibitors, meglitinides, SGLT2 inhibitors, sulfonylureas, and thiazolidinediones (TZDs).

10. Pancreas Transplant Information: For select patients with type 1 diabetes who have difficulty managing their diabetes or require a kidney transplant, discuss pancreas transplantation as a potential treatment option. Explain the benefits, risks, and need for lifelong immunosuppression.

11. Meal Planning Guidance: Provide guidance on diabetic meal planning, emphasizing:

• Carbohydrate counting and portion control
• Choosing complex carbohydrates over simple sugars
• Increasing intake of fruits, vegetables, lean proteins, and whole grains
• Limiting processed foods, sugary drinks, and unhealthy fats
• Reading food labels
• Consistent meal times

12. Nutritionist/Dietitian Referral: Refer patients to a registered dietitian or nutritionist for individualized meal planning and carbohydrate counting education.

13. Physical Activity Promotion: Encourage regular physical activity, aiming for at least 150 minutes of moderate-intensity exercise per week. Educate patients on:

• Benefits of exercise for glucose control, weight management, and cardiovascular health
• Types of exercise (aerobic, resistance training)
• Exercise safety precautions (monitoring blood glucose before, during, and after exercise; carrying a source of fast-acting glucose)
• Gradual exercise progression

14. Weight Management Support: For overweight or obese patients with type 2 diabetes or prediabetes, support weight loss efforts, even modest weight loss (5-7% of body weight) can significantly improve glucose control.

15. Gestational Diabetes Management: For women with gestational diabetes, implement interventions to manage blood glucose during pregnancy, including:

• Blood glucose monitoring
• Medical nutrition therapy
• Regular physical activity
• Insulin or oral hypoglycemic agents if needed
• Monitoring blood glucose during labor and postpartum

16. Diabetes Prevention in Prediabetes: For patients with prediabetes, emphasize lifestyle modifications to prevent progression to type 2 diabetes:

• Weight loss (if overweight or obese)
• Healthy diet
• Regular physical activity
• Smoking cessation
• Consideration of metformin therapy in high-risk individuals

17. Endocrinologist/Diabetologist Referral: Refer patients to an endocrinologist or diabetologist for specialized diabetes care, particularly for complex cases or when glycemic control is challenging.

Complication Prevention Interventions

Preventing or delaying diabetes complications is a critical aspect of nursing care.

1. Medical Alert Identification: Advise patients to wear a medical alert bracelet or necklace indicating they have diabetes. This is crucial for emergency situations, especially hypoglycemia or DKA.

2. Ophthalmologist Referral: Recommend annual eye exams by an ophthalmologist to screen for diabetic retinopathy, cataracts, and glaucoma.

3. Vaccination Promotion: Encourage recommended vaccinations, including influenza and pneumococcal vaccines, as diabetes can impair immune function and increase susceptibility to infections.

4. Foot Care Education: Provide comprehensive foot care education:

• Daily foot inspection for cuts, blisters, redness, swelling
• Daily washing of feet with lukewarm water and gentle soap
• Thorough drying, especially between toes
• Moisturizing dry skin (avoiding lotion between toes)
• Properly fitting shoes and socks
• Avoiding walking barefoot
• Promptly reporting any foot problems to a healthcare provider
• Regular podiatry visits, especially for patients with neuropathy or foot deformities

5. Blood Pressure and Cholesterol Management: Educate patients on the importance of managing blood pressure and cholesterol levels to reduce cardiovascular risk. Encourage healthy lifestyle habits and medication adherence as prescribed.

6. Oral Hygiene Education: Emphasize good oral hygiene practices, including:

• Brushing teeth at least twice daily and flossing daily
• Regular dental checkups
• Awareness of increased risk of gum disease in diabetes

7. Smoking Cessation Support: Strongly advise smokers with diabetes to quit smoking and provide resources and support for smoking cessation.

8. Moderate Alcohol Consumption Guidance: If patients choose to drink alcohol, advise moderation (no more than one drink per day for women, two for men) and to consume alcohol with food to minimize the risk of hypoglycemia.

9. Stress Management Techniques: Educate patients on stress management strategies, as chronic stress can negatively impact blood glucose control. Encourage relaxation techniques, exercise, adequate sleep, and seeking support systems.

10. Diabetes Nurse Educator Coordination: Collaborate with diabetes nurse educators to provide ongoing support and education to patients and their families.

11. DSMES Program Referral: Refer patients to Diabetes Self-Management Education and Support (DSMES) programs. DSMES programs provide structured education and support to improve self-management skills, health outcomes, and quality of life.

Diabetes Mellitus Nursing Care Plans

Nursing care plans provide a structured framework for delivering patient-centered care. Here are examples of nursing care plans for common nursing diagnoses related to diabetes mellitus:

Nursing Care Plan for Decreased Cardiac Output

Nursing Diagnosis: Decreased Cardiac Output related to cellular dysfunction secondary to insulin resistance or uncontrolled blood glucose levels, as evidenced by tachycardia, dyspnea, and edema.

Expected Outcomes:

• Patient will demonstrate adequate cardiac output as evidenced by stable vital signs (BP within patient’s baseline, HR 60-100 bpm, RR 12-20 breaths/min), urine output of 0.5-1.5 mL/kg/hour, strong peripheral pulses, and absence of dyspnea or altered mentation.
• Patient will verbalize understanding of factors contributing to decreased cardiac output in diabetes and strategies to improve cardiac function.

Nursing Interventions:

Assessment	Intervention	Rationale
1. Monitor heart rate, blood pressure, and respiratory rate frequently. Assess for tachycardia, hypotension, tachypnea, and dyspnea.	1. Administer supplemental oxygen as prescribed.	1. Compensatory tachycardia and hypotension are indicators of reduced cardiac output. Dyspnea and tachypnea may reflect fluid overload and respiratory distress.
2. Assess EKG rhythms and monitor for arrhythmias.	2. Maintain patient in a semi-Fowler’s or high-Fowler’s position.	2. Supplemental oxygen increases myocardial oxygen availability, alleviating hypoxemia and reducing cardiac workload.
3. Monitor daily weight at the same time each day. Assess for edema (peripheral, pulmonary).	3. Promote physical and emotional rest. Provide a quiet and calm environment.	3. Arrhythmias can compromise cardiac output and may require medical intervention. Continuous telemetry monitoring may be indicated.
4. Assess patient’s history for pre-existing cardiac conditions (hypertension, hyperlipidemia).	4. Administer medications as prescribed, such as SGLT2 inhibitors (canagliflozin, empagliflozin) or other cardiac medications.	4. Fluid retention is a consequence of decreased cardiac output. Daily weight monitoring provides crucial data on fluid balance. Edema is a clinical manifestation of fluid overload.
5. Assess for signs and symptoms of decreased cardiac output: fatigue, change in level of consciousness, decreased activity tolerance, decreased peripheral pulses, decreased urine output, anxiety, restlessness.	5. Educate the patient on the relationship between diabetes mellitus and cardiac dysfunction. Emphasize the importance of glycemic control, medication adherence, and lifestyle modifications to improve cardiac health.	5. Diabetes mellitus complicates pre-existing cardiac conditions and significantly increases the risk of cardiovascular disease due to vascular damage.

Nursing Care Plan for Ineffective Peripheral Tissue Perfusion

Nursing Diagnosis: Ineffective Peripheral Tissue Perfusion related to impaired oxygen transport and peripheral vascular disease secondary to elevated blood glucose levels, as evidenced by weak peripheral pulses, numbness, and delayed healing.

Expected Outcomes:

• Patient will maintain optimal peripheral tissue perfusion as evidenced by strong, palpable peripheral pulses, warm and dry extremities, capillary refill time < 3 seconds, and absence of burning or numbness in extremities.
• Patient will demonstrate behaviors to improve peripheral tissue perfusion, such as proper foot care and smoking cessation (if applicable).

Nursing Interventions:

Assessment	Intervention	Rationale
1. Monitor blood pressure, including orthostatic blood pressures. Assess for orthostatic hypotension.	1. Maintain controlled blood glucose levels within the target range. Educate patient on glucose monitoring, medication administration, and adherence to prescribed regimen.	1. Orthostatic hypotension in diabetic patients may indicate early neuropathy and hypertension.
2. Assess peripheral pulses bilaterally, using Doppler ultrasound if pulses are difficult to palpate. Document pulse quality (e.g., weak, absent).	2. Encourage the use of compression stockings, if appropriate and prescribed.	2. Maintaining optimal glucose levels is paramount for preventing perfusion complications. Consistent glucose control reduces endothelial damage and improves circulation.
3. Assess skin texture, color, temperature, and capillary refill time in extremities. Note any abnormalities such as thin, shiny skin, hair loss, brittle nails, cool temperature, delayed capillary refill, or ulcerations.	3. Provide meticulous foot care. Refer to a podiatrist for comprehensive foot assessment and care, especially if neuropathy or foot ulcers are present.	3. Doppler ultrasound enhances detection of peripheral blood flow when pulses are weak or non-palpable.
4. Assess patient’s sensation in lower extremities using monofilament testing and other neuropathy assessments.	4. Instruct patient on smoking cessation and provide resources for quitting.	4. Abnormal skin findings (thin, shiny skin, hair loss, ulcerations) indicate arterial insufficiency. Diabetes-related microvascular and macrovascular damage reduces circulation, impairing healing and increasing amputation risk.
5. Assess for pain, numbness, or altered sensation in extremities. Document location, character, and intensity of pain.	5. Educate patient on lifestyle factors that promote improved tissue perfusion: healthy diet, regular exercise, weight management, and stress reduction. Emphasize adherence to diabetes management plan and medications for hypertension and hyperlipidemia.	5. Neuropathy reduces protective sensation, increasing risk of injury and undetected foot problems. Monofilament testing assesses protective sensation.

Nursing Care Plan for Risk for Unstable Blood Glucose Level

Nursing Diagnosis: Risk for Unstable Blood Glucose Level related to unfamiliarity with diagnosis, inadequate glucose monitoring, incorrect insulin administration, and insufficient dietary intake.

Expected Outcomes:

• Patient will achieve and maintain blood glucose levels within the acceptable target range as evidenced by blood glucose monitoring records.
• Patient will verbalize understanding of factors that influence blood glucose levels (diet, exercise, medications, stress, illness).
• Patient will demonstrate appropriate self-management behaviors to prevent hypo- and hyperglycemia.
• Patient will verbalize symptoms of hypoglycemia and hyperglycemia and appropriate actions to take in each situation.

Nursing Interventions:

Assessment	Intervention	Rationale
1. Assess for signs and symptoms of hypo- and hyperglycemia: shakiness, dizziness, sweating, hunger, confusion (hypoglycemia); thirst, frequent urination, blurred vision, headache, fatigue (hyperglycemia).	1. Administer diabetic medications (oral agents and/or insulin) as prescribed and scheduled. Monitor blood glucose levels before medication administration and as ordered (e.g., AC and HS).	1. Early recognition of hypo- and hyperglycemia allows for prompt intervention to prevent serious complications.
2. Assess patient’s physical activity level and patterns. Inquire about glucose monitoring practices before, during, and after exercise.	2. Instruct patient on carbohydrate counting and meal planning. Provide guidance on portion control, food choices, and consistent meal times.	2. Diabetic medications are essential for regulating blood glucose levels. Hospitalized patients may require adjusted insulin doses due to stress, illness, or medications that affect glucose levels (e.g., steroids).
3. Review patient’s HbA1c results to assess long-term glycemic control.	3. Educate patient on how to monitor blood glucose levels accurately using a glucometer. Provide return demonstration and address any questions or concerns. Consider continuous glucose monitoring (CGM) for patients with complex insulin regimens or hypoglycemia unawareness.	3. Carbohydrates are metabolized into glucose, directly impacting blood glucose levels. Carbohydrate counting helps patients match insulin doses to carbohydrate intake. Consistent meal timing promotes blood glucose stability.
4. Assess patient’s understanding and knowledge of diabetes management, including medication administration, glucose monitoring, diet, exercise, and sick day management.	4. Teach patient how to recognize, treat, and prevent hypoglycemia and hyperglycemia. Provide specific instructions on treating hypoglycemia (e.g., using glucose tablets or fast-acting carbohydrates).	4. HbA1c reflects average glucose levels over 2-3 months, providing valuable information about long-term glycemic control.
5. Assess patient’s support system and ability to self-manage diabetes independently. Identify any barriers to self-management (cognitive impairment, physical limitations, age).	5. Refer patient to Diabetes Self-Management Education (DSME) program for comprehensive diabetes education, support, and skill-building. Coordinate with a diabetes nurse educator for ongoing support and individualized education.	5. Knowledge deficit is a major risk factor for unstable blood glucose levels. Assessing patient’s understanding guides tailored education interventions.

These nursing care plans are examples and should be individualized based on the patient’s specific needs and clinical situation.

References

• American Diabetes Association. (2023). Standards of medical care in diabetes—2023 abridged for primary care providers. Clinical Diabetes, 41(1), 4-31.
• Национальный институт диабета и болезней органов пищеварения и почек. (n.d.). Diabetes mellitus.
• Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth’s textbook of medical-surgical nursing (14th ed.). Wolters Kluwer.