Unstable blood glucose refers to a deviation from normal blood glucose levels that results in either hyperglycemia or hypoglycemia. Unstable blood glucose does not necessarily mean the patient is diabetic. For example, in temporary situations such as dehydration or pregnancy, when the source is resolved, blood sugar levels may return to normal.
That being said, unstable glucose levels are a common problem for those with diabetes. Controlling glucose levels is important as untreated diabetes can result in long-term complications that affect almost every part of the body such as the heart, kidneys, eyes, and nerves. Nurses can investigate the potential causes of unstable glucose levels and provide education and resources to patients and families to prevent the occurrence.
Causes of Risk For Unstable Blood Glucose (Related to)
- Denial of diagnosis
- Deficient knowledge of diabetes or treatment
- Poor adherence to diabetes management
- Financial strain
- Dietary intake
- Weight gain or loss
- Pregnancy
- Activity level
- Stress
- Developmental level
Note: A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred and the goal of nursing interventions is aimed at prevention.
Expected Outcomes
- Patient will identify factors that may contribute to unstable glucose
- Patient will maintain blood glucose level within normal limits
- Patient will demonstrate proper technique for monitoring glucose levels
Nursing Assessment for Risk For Unstable Blood Glucose
1. Determine factors that increase the risk of unstable glucose.
Poor glucose control, over or undereating, morbid obesity, lack of exercise or overexercising, growth spurts in adolescence, and pregnancy are common causes of unstable glucose.
2. Assess the patient’s understanding of their disease.
Allow time for open-ended questions and discussion to assess the patient’s knowledge of diabetes. Ask them how their insulin (or oral antidiabetic) works and why it is needed as well as how they should monitor their glucose and how to recognize hyperglycemia or hypoglycemia. This allows the nurse to assess for a knowledge deficit and educate accordingly.
3. Assess for nonadherence.
Assess for missed doses of medications, inconsistent glucose monitoring, and poor diet adherence. Ask questions such as “How many doses of insulin have you missed in the last 2 weeks” or “What do you eat on an average day?”
4. Review all medications.
Review for other medications taken that could interfere with glucose levels. Antidepressants, corticosteroids, oral contraceptives, and over-the-counter cold medicines can increase blood glucose while antibiotics and some heart/blood pressure medications can increase and lower glucose levels.
5. Assess diet and eating patterns.
Inconsistent eating patterns can cause poor glucose control. Missed meals can lead to hypoglycemia while diets high in carbs and sugar cause hyperglycemia.
6. Assess alcohol intake.
Alcohol use competes with the liver, which is the organ that stabilizes glucose levels. If the liver is metabolizing alcohol it may not control glucose levels which can cause hypoglycemia, especially on an empty stomach or if taken with antidiabetic medications.
7. Assess family support.
Assess for a lack of support that may be causing issues with obtaining medications, administering insulin, or preparing food.
8. Monitor A1C.
Hemoglobin A1C results show average glucose levels over 3 months. It can be useful in monitoring how diabetes treatment is working overtime. The goal for adults with diabetes is < 7%. An A1C higher than this points to poor glucose control.
Nursing Interventions for Risk For Unstable Blood Glucose
1. Have patient bring glucose monitor and demonstrate use.
Ensure the monitor is working properly and then observe the patient checking their glucose. Ensure they are performing all steps of the fingerstick correctly.
2. Have patient demonstrate insulin administration.
Ensure they understand how to draw up their insulin (or use the dial on an insulin pen) and that they are rotating subcutaneous fat sites and cleaning the site before injection.
3. Recommend keeping a glucose level log.
Provide the patient with a form or instruct to use a notebook and write down their glucose levels every day. This will help the provider understand any patterns and the need for any treatment changes.
4. Refer to a dietician.
Dieticians can instruct on specific dietary changes and provide resources on which foods to eat, what to limit, and how to read food labels.
5. Educate on signs of hyper/hypoglycemia and treatment.
Provide education on signs of hyperglycemia: headache, dry mouth, increased thirst or hunger, and hypoglycemia: sweating/chills, shakiness, feeling lightheaded or dizzy. Tighter control of high blood sugar occurs with exercise and better eating habits. If hypoglycemic, eat a fast-acting glucose snack like juice or hard candy. Frequent episodes of hyper/hypoglycemia may need medication adjustment.
6. Teach carb-counting.
Instruct on different types of carbs (sugars, starches, and fiber) and the effect of carbs on blood glucose and insulin levels. Carbs are measured in grams and 1 serving = 15 g of carbs. Each person will require an individualized amount of carbs depending on their caloric intake, weight, and activity level.
7. Discuss healthy exercise habits.
Everyone should exercise to maintain cardiovascular health, control weight, improve mental health, and maintain glycemic control. Exercise lowers glucose and makes the body more sensitive to insulin. This is a good thing but can cause hypoglycemia if the patient does not monitor their medication and carb intake prior to physical activity.
8. Discuss other glucose monitoring systems.
For patients who are developmentally delayed or are nonadherent to typical fingerstick glucose monitoring, there are other options. The nurse can discuss with the provider to see if they may be eligible for new technological devices such a Dexcom, a wearable continuous glucose device.
9. Involve a diabetes educator.
Most hospitals employ diabetes educators to educate diabetics on how to manage their disease. They can be powerful motivators to help them with behavior change to meet their health goals.
10. Offer resources for supplies.
Diabetic medications and supplies can be very costly. If a patient is at risk for unstable glucose due to a lack of ability to afford their insulin or supplies, there are financial resources and programs available they may be eligible for.
References and Sources
- Alcohol and Diabetes | ADA. (n.d.). American Diabetes Association. Retrieved December 10, 2021, from https://www.diabetes.org/healthy-living/medication-treatments/alcohol-diabetes
- Blood Sugar and Exercise | ADA. (n.d.). American Diabetes Association. Retrieved December 10, 2021, from https://www.diabetes.org/healthy-living/fitness/getting-started-safely/blood-glucose-and-exercise
- Callahan, A. (2018, March 6). 7 Medications That May Affect Blood Sugar Control in Diabetes. Everyday Health. Retrieved December 10, 2021, from https://www.everydayhealth.com/type-2-diabetes/treatment/medications-may-affect-blood-sugar-control-diabetes/
- Carb Counting. (n.d.). CDC. Retrieved December 10, 2021, from https://www.cdc.gov/diabetes/managing/eat-well/diabetes-and-carbohydrates.html
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- Understanding A1C | ADA. (n.d.). American Diabetes Association. Retrieved December 10, 2021, from https://www.diabetes.org/a1c
