The nurse cares for a client with type 1 diabetes mellitus who is obtunded and responding to only painful stimuli. A STAT blood sample reveals a blood glucose level of 38 mg/dL (2.11 mmol/L). Which initial action by the nurse is best?

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Hypoglycemia, a potentially life-threatening complication of diabetes mellitus, is identified by blood glucose <70 mg/dL (<3.9 mmol/L) and often occurs as a result of illness or inappropriate use of antidiabetic medications. When blood glucose levels (BGLs) are low, the body activates the autonomic nervous system, causing shakiness, palpitations, and sweating. Without intervention, hypoglycemia may cause altered mental status (eg, difficulty speaking, confusion), which may progress to seizures, coma, and death. Nurses caring for clients with hypoglycemia and altered mental status or dysphagia should immediately administer IV glucose replacement (eg, 50% dextrose in water) to quickly restore BGLs and prevent potentially lethal neurological changes (Option A). Afterward, the nurse should retest the BGL every 15 minutes, repeating treatment if it remains low. (Option B) Clients with altered mental status (eg, obtunded, responsive only to painful stimuli) are at high risk for aspiration and are not appropriate candidates for oral glucose replacement. (Options C and D) Obtundation, a sign of severe hypoglycemia, and a confirmed BGL of 38 mg/dL (2.11 mmol/L) are sufficient indicators for implementing emergency intervention. Assessment of additional signs of hypoglycemia, heart rate, and blood pressure should not delay implementation of lifesaving treatment. Educational objective: Hypoglycemia is a complication of diabetes mellitus that can lead to coma, seizures, and death without prompt intervention. Nurses caring for clients with hypoglycemia and altered mental status should administer IV glucose to quickly restore blood glucose levels. Lifesaving treatment should not be delayed to perform further assessments.

The Nurse Cares for a Client with Type 1 Diabetes