The Basics
This diagnostic laboratory test measures the percentage of hemoglobin coated with glucose, reflecting a patient's average blood sugar over the past 2 to 3 months.
What is an HbA1c (Glycated Hemoglobin) test?
This acute emergency state features a gradual onset, a blood glucose level characteristically greater than 800 mg/dL, and an absence of significant ketones.
What is Hyperglycemic Hyperosmolar State (HHS)
This is Emanate Health’s official inpatient blood glucose target range for hospitalized patients.
What is 140 mg/dL to 180 mg/dL
These are the safest four anatomical areas approved for subcutaneous insulin administration.
What are the sides of the thighs, back of the upper arms, abdomen, and upper outer buttocks?
This is the required frequency for checking point-of-care blood glucose levels (gPOCT) on any patient running a continuous insulin infusion.
What is every 1 hour (q1h)?
This specific type of diabetes is classified as an autoimmune disease where the body’s immune system mistakenly attacks and completely destroys its own insulin-producing pancreatic beta cells.
What is Type 1 Diabetes Mellitus (DM1)?
Diabetic Ketoacidosis (DKA) in acute emergency state features a rapid onset (typically 24 hours) and an elevated anion gap.
Give the blood glucose range/levels and name 2 other findings?
Other findings: Acetone breath and Kussmaul breathing
According to the hospital pharmacy protocol, all insulin should be held if the patient’s blood glucose drops below this specific level
What is less than 100 mg/dL
This is the primary reason why nurses must systematically rotate injection sites within the same anatomical area.
What is to avoid the risk of lipohypertrophy (or lipodystrophy).
If a patient's blood glucose level does not decrease by at least this amount within 2 hours, the protocol dictates moving up to the next higher algorithm.
What is 50 mg/dL?
Unlike Type 1 diabetes which has a rapid onset typically starting in childhood, Type 2 diabetes develops slowly and is driven by these two combined physiological factors.
What are insulin resistance and inadequate insulin secretion (progressive beta-cell dysfunction)?
These five medical or physical events are cited as the primary "triggers" that cause a patient to slip into DKA or HHS.
What is illness causing decreased PO intake, heart attack/stroke, physical injury, alcohol/drug use, or medications like diuretics and steroids?
This is the mandatory safety action required for a scheduled dose of Novolog (Nutritional) insulin if the patient is made NPO.
What is HOLD the dose
This is the core "sliding scale" practice danger demonstrated by a severe up-and-down wave graphic on a patient's chart.
What is the Roller Coaster Effect?
These two specific criteria require a nurse to move down to the next lower titration algorithm table.
What is when the blood glucose is less than 100 mg/dL for 2 hours, OR if the drip rate is decreased 2 consecutive times.
A patient is alert and able to swallow. Their blood glucose is 46 mg/dL. You administer 15 g of oral carbohydrate and recheck the glucose 15 minutes later. It is still 48 mg/dL. After a second 15-g oral treatment, the glucose remains 47 mg/dL.
According to the hypoglycemia protocol, what is the next treatment?
What is administer 12.5 g (25 mL) of D50W IV. If no IV access is available, the protocol directs the nurse to start 0.45% normal saline IV. Continue to recheck BG every 15 minutes until BG >70 mg/dL.
This is the absolute first fluid management focus for an adult in a hyperglycemic crisis, which must be titrated cautiously in patients with comorbidities like CHF.
What is rapid infusion of 1 to 3 liters of Normal Saline (or 0.45% NS if sodium is high/normal)
If an NPO patient has a high blood glucose level, this specific insulin order should never be held, as it is given in addition to nutritional doses to correct current hyperglycemia.
What is Novolog (Correctional) insulin
These four specific topics must be prioritized when building an individualized care plan to teach "survival skills" to a diabetic patient.
What are medication management, signs/symptoms of hypo/hyperglycemia, blood glucose monitoring, and diet management?
If a patient's initial blood glucose is 359 mg/dL and the provider initiates standard Algorithm 1, this is the exact starting insulin infusion rate.
What is 4 units/hr?
BONUS!!
A patient with suspected hypoglycemia is unconscious, and a bedside blood glucose reading is not immediately available. IV access is present. The nurse is deciding whether to wait for the glucose result before treating.
What should the nurse do according to the protocol?
Bonus Question: What actions would be taken per protocol if IV access could not be obtained in an altered/unconscious patient?
What is Administer 25 g (50 mL) of D50W IV immediately and obtain/check the blood glucose as soon as possible. The protocol does not require waiting for the BG result when the patient is unconscious and testing is not immediately available.
Bonus challenge: If IV access could not be obtained expediently in an altered/unconscious patient, the protocol specifies glucagon 1 mg IM and positioning the patient on their side.
Per the Potassium Repletion Protocol, if a patient's initial potassium level drops below this critical threshold, you must hold the initiation of the IV insulin infusion completely and replace the electrolyte.
What is 3.3 mEq/L
If a patient’s nutritional status shifts to NPO, this is the rule regarding their long-acting basal insulin (Levemir/Lantus).
What is DO NOT skip the dose (Contact Pharmacy to adjust the dose instead)
This mandatory clinical milestone must be safely achieved by a patient before they can be discharged home on insulin therapy.
What is they must safely demonstrate insulin administration.
To prevent a rebound recurrence of ketoacidosis, an IV insulin drip must remain running for this long after a rapid-acting subcutaneous basal-bolus regimen is first injected.
What is 1 to 2 hours.