Regardless of what field of nursing you work in or plan on working in once you complete nursing school, you will absolutely encounter diabetic patients and participate in the management of their diabetes. Over 10% of all Americans have diabetes and many of these patients are insulin-dependent. Identifying when your patient has critically high or low blood sugar quickly will help you to provide the proper treatments to reverse the issue.
“Cool and clammy, give ‘em candy.”
Typical symptoms of hypoglycemia are cool skin, diaphoresis or clamminess, confusion, and sometimes aggression. Despite the reasons why your patient is under your care, a diabetic patient presenting with confusion who is “cool and clammy” should have their glucose checked immediately as part of the initial assessment.
Once when I was working as a restaurant manager, a server ran to the kitchen to find me. Aware that I also worked as an EMT, my staff summoned me to check on a customer in the dining room who looked as though he was about to faint. The man was pale and his skin was clammy. I asked him some basic questions but he was unable to answer me. I saw a medical alert bracelet and immediately asked his wife if he had diabetes. Fairly elderly, the wife was in a bit of a panic over the situation, but she was able to nod yes. Without the means of checking his sugar to confirm, I acted based on my assessment and ran to the pantry.
Fortunately, we had just started serving brunch at this restaurant the weekend prior so we had gallons of maple syrup on the shelf. I filled a soup cup with syrup, grabbed a spoon, and scurried back to the patient. My servers had him surrounded to ensure he did not fall out of his chair. I began to feed him the golden sugary syrup one spoonful at a time. The results were almost immediate. Color returned to his face and the man looked at me. Chuckling, he thanked me for the assistance and assured me this would be the last time he took his insulin such a long time before his meal.
My staff was impressed and, as I returned to the kitchen to continue on with lunch service, I shrugged to the server taking care of the gentleman’s table and said “cool and clammy, give ‘em candy.”
Fortunately, just as we can poetically remember symptomatically-hypoglycemic patients need sugar, we can also remember that if a patient is “hot and dry, sugar’s high.” Diagnosis of a symptomatic hyperglycemic patient can be a little trickier, however, as the symptoms tend to take much longer to exacerbate. These patients will typically require a combination of insulin to slowly and steadily bring their glucose down to a safe level without dropping too low. Fortunately, most symptomatic hyperglycemia patients will earn a bed in an intermediate or critical care area and can receive more attention with a lower nurse-to-patient ratio.
In any case, whether the patient’s glucose is suspected of being low or high, or perhaps their symptoms are from another cause altogether, be sure to follow your institution or agency’s protocols regarding the treatment of diabetic patients and confirm a glucose level before acting. As a new nurse, it is important to study up on these protocols. I also recommend writing them out in your notes or on a reference card for quick access in the event of an emergency.