d. Nursing management.
Administer glucose immediately.
(a) A conscious patient may be given some form of sugar by mouth.
(Table sugar, orange juice, cola, honey, syrup, jelly, or candy.)
(b) An unresponsive patient may be given "instant glucose," a form of
rapidly absorbed glucose that is squeezed out of a tube into the patient's mouth for oral
An intravenous infusion of dextrose in water should be initiated if
Have the patient stop all activity and rest to conserve energy.
Notify the physician.
Draw blood for a glucose level.
Monitor vital signs and level of consciousness carefully.
Document all information in the patient's clinical record.
1-74. HYPERGLYCEMIA AND KETOACIDOSIS
a. Hyperglycemia and ketoacidosis (also referred to as diabetic coma) result
from too much sugar in the blood (in relation to the amount of insulin). This situation
can be caused by eating more food than allowed, taking too little or no insulin, illness, or
infection. Remember that insulin regulates glucose metabolism and that insufficient
insulin will cause an inability to utilize the glucose. Glucose accumulates in the blood
(hyperglycemia) and is unable to be used as a source of energy due to the lack of
insulin. When glucose cannot be utilized, the body must break down fats and proteins
for energy. If too many by-products of fat and protein metabolism (ketones) accumulate
in the body, an acid-base imbalance will occur. This condition is called acidosis, or
ketoacidosis. If this condition is left undetected or untreated, coma and death will result.
b. Signs and symptoms of diabetic ketoacidosis include the following. Onset is
gradual, occurring over several hours to several days.
Hot, dry, flushed skin.
Absence of sweating.
"Fruity" odor to breath (acetone).