Hypoglycemia is low blood glucose. Patients who have diabetes may have episodes of hypoglycemia or hyperglycemia due to the body’s inability to produce or regulate insulin. Hypoglycemia is most likely to occur in diabetic patients due to the misadministration of insulin.
Hypoglycemia can also occur in patients who are not diabetic due to causes such as excessive alcohol use, malnutrition, and chronic conditions that affect the liver.
The symptoms of hypoglycemia include:
- Shakiness
- Hunger
- Headaches
- Pale color (Pallor)
- Sweating
- Palpitations
- Impaired vision
- Weakness
The brain requires glucose to function. If blood glucose levels fall, the brain stops working. This will result in loss of consciousness and changes in cognition. Untreated, symptoms can worsen and lead to seizures, coma, and death.
Despite a low blood sugar level, some patients may be asymptomatic. The severity of hypoglycemia and symptoms will drive treatment. It’s important to teach patients how to recognize and when to self-treat hypoglycemia. In a clinical setting, a 50% glucose intravenous (IV) solution is given to a patient who has seizures, is unable to eat, or has very low blood glucose levels. In the absence of an IV access, 1 mg of glucagon intramuscular (IM) is administered.
The Nursing Process
The nursing assessment focuses on the patient’s physical and mental symptoms. A thorough history of dietary habits, comorbidities, and medications is also necessary.
Nursing interventions include health teaching about the following:
- Causes of hypoglycemia
- Need for diagnostic tests
- Recording and evaluation of symptoms
- Administration of antidiabetic medications
- Causes and prevention of hypoglycemia
- Reinforcing dietary advice and limitations
Nurses are essential in providing ongoing health education. Successful monitoring and patient education can reduce the incidents of hypoglycemia and its complications.
Nursing Care Plans Related to Hypoglycemia
Acute Confusion
Acute confusion can result from hypoglycemia. Low blood glucose may cause a reversible loss of consciousness and confusion.
Nursing Diagnosis: Acute Confusion
Related to:
- Inadequate glucose for cellular brain function
- Malfunction of the vasomotor of the brain
As evidenced by:
- Changes in mentation
- Agitation
- Restlessness
- Alteration in the level of consciousness
- Alteration in psychomotor functioning
- Misperception
- Delirium
- Failure to initiate purposeful or goal-directed behavior
- Failure to follow commands
Expected outcomes:
- Patient will be alert and oriented x4, or at their baseline level of cognition
- Patient will verbalize 3 symptoms of confusion and change in cognition to monitor for
- Patient will not display a decrease in consciousness, restlessness, or agitation
Acute Confusion Assessment
1. Determine additional risk factors for confusion.
Review the patient’s risk factors to determine if confusion is related to hypoglycemia or other conditions such as:
- Low levels of oxygen (hypoxia)
- Metabolic, endocrine, or neurological diseases
- Toxins, electrolyte imbalances
- Systemic or central nervous system infections
- Nutritional deficiencies
- Acute psychiatric disorders
2. Assess the patient’s mental status.
Changes in mental status can occur abruptly and progress over hours or days. The nurse should closely monitor for subtle changes.
3. Monitor the patient’s blood glucose level.
A change in mental status should always alert the nurse to obtain a glucose level. This is an easy and quick way to identify or rule out hypoglycemia.
Acute Confusion Interventions
1. Manage the underlying condition.
Confusion is a symptom of hypoglycemia. It is necessary to manage the underlying issue to resolve the confusion.
2. Review current medications and usage.
A review of current medications and usage is important, particularly for diabetic patients. The common cause of hypoglycemia is excessive insulin administration. Ensure the patient understands how and when to administer insulin.
3. Provide safety.
Worsening or unrecognized hypoglycemia can cause seizures or inappropriate behavior. It is the nurse’s responsibility to keep the patient safe in the event of a seizure and prevent the risk of injury through fall precautions.
4. Instruct on recognizing symptoms.
Educate the patient and family on changes that signal hypoglycemia. These can be individualized for each patient and take time to recognize. A change in personality such as irritability, forgetfulness, slurred speech, drowsiness can be symptoms.
5. Teach how to administer glucose.
In the hospital, the nurse can administer D50 IV to quickly treat hypoglycemia when the patient is not alert or oriented. Glucagon may be given IM and the family can be educated on its administration. If the patient is capable of swallowing safely, juice, milk, or glucose gel can be given.
Risk for Unstable Blood Glucose Level
Risk for unstable blood glucose levels can be applied to patients who have difficulty maintaining normal glucose levels, resulting in hypoglycemia and other health conditions.
Nursing Diagnosis: Risk for Unstable Blood Glucose
Related to:
- Denial of the diagnosis
- Inadequate knowledge of diabetes management
- Excessive stress
- Nonadherence to diabetes treatment plan
- Insufficient blood glucose monitoring
- Inappropriate insulin administration
- Deficient dietary intake
- Excessive weight gain or loss
- Pregnancy
- Excessive exercise
Expected outcomes:
- Patient will be able to maintain glucose levels within normal limits
- Patient will be able to verbalize knowledge of energy requirements
- Patient will be able to modify behavior and lifestyle to maintain blood glucose levels within normal limits
Risk for Unstable Blood Glucose Level Assessment
1. Identify risk factors.
Causes of glucose fluctuations include the following:
- Chronic conditions causing poor glucose control
- Eating disorders (such as morbid obesity)
- Exercise habits
- Adolescent growth spurts
- Pregnancy
- Side effect of anti-diabetic medication
- Stress
2. Assess perceptions and cultural impacts.
The patient’s dietary habits, medication adherence, and perception of their illness may be influenced by cultural or religious beliefs.
3. Assess the patient or caregiver’s ability to use their glucose monitoring device.
Proper supplies, technique, and equipment can impact the accuracy of the results. Have the patient or family member demonstrate how they use their glucometer.
Risk for Unstable Blood Glucose Level Interventions
1. Educate on diet and exercise requirements.
Help the patient recognize the need for increased food for energy when partaking in exercise or physical activities to prevent a drop in glucose.
2. Help the patient recognize occasions that contribute to hypoglycemia.
Missed meals, illness/infection, overdoses of insulin, weight changes, stress, and more can contribute to low glucose levels.
3. Provide health teaching about the patient’s antidiabetic medications.
Provide education to help the patient understand how their medications work. Ensure they are administering the medication correctly, in the correct dose, and at the correct time.
4. Inform of complications and consequences.
Unstable glucose levels damage blood vessels and harm organ systems. Long-term complications can include kidney disease, eye problems, and heart conditions.
Deficient Knowledge
Deficient knowledge associated with hypoglycemia can be caused by misinformation or interpretations, or failure to recall correct information about hypoglycemia and its management.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Inadequate knowledge about hypoglycemia
- Lack of knowledge about the management of hypoglycemia
- Insufficient knowledge of self-care management
- Wrong information or interpretations
- Failure to recall correct information about hypoglycemia
As evidenced by:
- Development of hypoglycemia and complications
- Verbalization of concerns
- Inquiries about hypoglycemia and its management
- Misconceptions about hypoglycemia and its management
- Inaccurate or insufficient instructions in self-care
- Progress of preventable complications
- Nonadherence with treatment
- Incorrect demonstration of medication administration or glucometer use
Expected outcomes:
- Patient will be able to verbalize causes and symptoms of hypoglycemia and self-care management.
- Patient will be able to demonstrate 2 behavior and lifestyle modifications to prevent hypoglycemia.
Deficient knowledge Assessment
1. Assess the patient’s knowledge level of hypoglycemia.
Patients’ awareness of hypoglycemia and self-care management affects outcomes. Have the patient teach back the causes of hypoglycemia and how it can be prevented and treated.
2. Establish the patient’s capacity, readiness, and learning obstacles.
Ensure the patient is willing, motivated, and capable of learning. Provide information in several forms at their level of education.
3. Recognize avoidance cues.
Avoidance may occur as a result of a diagnosis of a lifelong condition. It can be difficult for patients to accept information if they are in denial.
Deficient knowledge Interventions
1. Identify the patient’s motivating elements.
Recognize the patient’s motivating elements, which can be either positive or negative. Identify specific goals to motivate the patient to seek information and succeed.
2. Provide facts about hypoglycemia and its management.
Listen to the patient’s concerns and personal barriers causing poor glycemic control. Patients may need information explained in a different way or reiterated in small chunks.
3. Encourage using positive reinforcement.
Reinforcement can promote new skills or behavior modification. Positive feedback inspires continued attempts to control blood glucose levels. Avoid using punishment (e.g., criticism, threats) as this will further discourage the patient.
4. Consult with a diabetes educator.
Diabetes educators are a wealth of knowledge, especially for newly diagnosed patients. They can assist the patient with bridging education gaps and teaching new ways to understand their complex disease.
References and Sources
- Dewit, S. C., Stromberg, H., & Dallred, C. (2017). Care of Patients With Diabetes and Hypoglycemia. In Medical-surgical nursing: Concepts & practice (3rd ed., pp. 1495-1496). Elsevier Health Sciences.
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, interventions, and rationales (15th ed.). F A Davis Company.
- Ignatavicius, D. D., Workman, M. L., & Rebar, C. (2018). Medical-Surgical Nursing: Patient-centered Collaborative Care, single volume (3rd ed., pp. 1494-1496). Saunders.
- Ignatavicius, MS, RN, CNE, ANEF, D. D., Workman, PhD, RN, FAAN, M. L., Rebar, PhD, MBA, RN, COI, C. R., & Heimgartner, MSN, RN, COI, N. M. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care (9th ed., pp. 2560-2565). Elsevier.
- Nettina, S. M. (2019). Pediatric Primary Care. In Lippincott manual of nursing practice (11th ed., pp. 2158-2177). Lippincott-Raven Publishers.
