Nursing Care Plans for Unstable Blood Glucose Level – Best Nursing Care Plans(2022)

This article discusses Nursing Care Plans for Unstable Blood Glucose Level plus its causes, symptoms, preventions, treatments, and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

Unstable Blood Glucose Levels mean that blood sugar levels swing frequently and can be severe. This version is rare and happens mainly to people with Type 1 diabetes. It is also called Brittle diabetes. It is challenging to manage and often disrupts everyday life. The swings can cause frequent episodes of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar).

Nursing Care Plans for Unstable Blood Glucose Level – What’s the difference between diabetes and unstable diabetes?

With treatment and lifestyle changes, most people with diabetes can live healthy lives. But people with brittle diabetes have frequent problems managing the disease that can:

• Affect their ability to live life normally.
• Cause anxiety and depression.
• Lead to hospitalization or even death.

Nursing Care Plans for Unstable Blood Glucose Level – How common is brittle diabetes?

Brittle diabetes is rare. It affects only about 3 of every 1,000 people with insulin-dependent diabetes.

Nursing Care Plans for Unstable Blood Glucose Level – Who might get brittle diabetes?

Brittle diabetes occurs most often in people with Type 1 diabetes (in Type 1, the body does not produce insulin). For reasons not fully understood, it’s most common in women in their 20s and 30s.

Nursing Care Plans for Unstable Blood Glucose Level – Symptoms of Unstable Blood Glucose Levels

People with brittle diabetes experience sudden and frequent changes in blood glucose levels for no obvious reason. The swings lead to hypoglycemia or hyperglycemia.

Symptoms of hypoglycemia include:

• Dizziness, weakness, or shaking.
• Fast heart rate.
• Irritability or confusion.
• Pale skin.
• Restless sleep.
• Sweating.
• Sudden hunger.

Symptoms of hyperglycemia include:

• Blurry vision.
• Fatigue (feeling weak, tired).
• Frequent urination (peeing).
• Headache.
• Skin infections and slow-healing cuts.
• Thirst or hunger.

Untreated hyperglycemia can lead to diabetic ketoacidosis, a complication of diabetes, which can cause:

• Confusion.
• Dehydration.
• Fast heart rate.
• Fruity-smelling breath.
• Trouble breathing.
• Vomiting.
• Coma.

Nursing Care Plans for Unstable Blood Glucose Level – Causes of Unstable Blood Glucose Levels

Brittle diabetes occurs when diabetes is especially difficult to manage. Diabetes can be hard to manage for many reasons:

• Celiac disease is an autoimmune disorder that affects the intestine.
• Drug or alcohol use.
• Eating disorders.
• Gastroparesis is a condition in which nerve damage prevents the stomach from emptying food properly.
• Hormonal imbalances, such as adrenal insufficiency and hypothyroidism.
• Problems in the way the body absorbs insulin or nutrients from food.
• Stress, anxiety, depression, and other psychological issues can make the body resist insulin.

Nursing Care Plans for Unstable Blood Glucose Level – Diagnosis of Unstable Blood Glucose Levels

Brittle diabetes is diagnosed after severe, frequent episodes of hypoglycemia or hyperglycemia that disrupt life or lead to hospitalizations. A healthcare provider specializing in diabetes (endocrinologist) can diagnose brittle diabetes by reviewing blood glucose levels over time.

Nursing Care Plans for Unstable Blood Glucose Level – Treatment of Unstable Blood Glucose Levels

Several treatments and technologies can help people with brittle diabetes manage the condition. They include:

• Continuous glucose monitor.
• Insulin pump.
• Islet cell transplantation: A healthcare provider takes healthy insulin-producing cells from a deceased person’s pancreas and infuses them into the liver.
• Pancreas transplant: A surgeon implants a donated pancreas.

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Nursing Care Plans for Unstable Blood Glucose Level – Prevention of Unstable Blood Glucose Levels

It’s not always possible to prevent brittle diabetes, depending on the underlying cause. Monitoring blood glucose regularly and closely following healthcare providers’ instructions can help.

Nursing Care Plans for Unstable Blood Glucose Level

Nursing Care Plans for Unstable Blood Glucose Level: Nursing Care Plan 1 – Diagnosis: Diabetes Mellitus

Desired Outcome

The patient will maintain a blood glucose level of less than 180 mg/dL and an A1C level below 5.7

Intervention	Rationale
Assess for signs of hyperglycemia or hypoglycemia.	To determine the appropriate treatment in maintaining target blood glucose levels. Symptoms of Hyperglycemia: 3P’s (polyphagia, polyuria, and polydipsia), fatigue or blurred vision Hypoglycemia: dizziness, headache, fatigue, diaphoresis, and tachycardia
Monitor blood glucose levels. Note that the frequency of blood glucose checks depends on the treatment plan.	To ensure that the blood glucose level is within a target range.
Administer diabetic medication (oral and/or insulin therapy) as prescribed.	To keep the glucose levels within normal range, effectively controlling diabetes and reducing the risk for blood vessel damage, nerve damage, kidney injury, and other complications of diabetes.
Advise the patient to adhere to his/her dietary plan.	Low fat, low calories, and high fiber foods are ideal for diabetic patients.
Encourage the patient to increase physical activity, particularly aerobic exercise.	Exercise decreases blood glucose levels as the cells’ demand for glucose (energy) increases with physical activity.

Nursing Care Plans for Unstable Blood Glucose Level: Nursing Care Plan 2 – Diagnosis: Side effect of Medications

Related to steroid use (steroid-induced diabetes)

Desired Outcome

The patient will maintain a blood glucose level of less than 180 mg/dL.

Intervention	Rationale
1. Assess for signs of hyperglycemia or hypoglycemia.	To determine the appropriate treatment in maintaining target blood glucose levels. Symptoms of Hyperglycemia: 3P’s (polyphagia, polyuria, and polydipsia), fatigue or blurred vision Hypoglycemia: dizziness, headache, fatigue, diaphoresis, and tachycardia
2. For a patient without pre-existing diabetes, monitor blood glucose levels at least once a day, ideally before lunch or evening meal. For a patient with pre-existing diabetes, monitor capillary blood glucose levels 4 times a day – before or after meals and before bedtime.	To ensure that the blood glucose level is within the target range.
3. Commence diabetic management as prescribed. This can be either: Non-insulin therapy – administer sulphonylureas which promote insulin release from the beta cells of the pancreas, or Insulin therapy – administration of subcutaneous basal human insulin in the morning	To keep the glucose levels within normal range, effectively controlling steroid-induced diabetes and reducing the risk for blood vessel damage, nerve damage, kidney injury, and other complications of diabetes.
Encourage the patient to adhere to his/her dietary plan as set by the diabetes specialist dietitian.	Low fat, low calories, and high fiber foods are ideal for patients with steroid-induced diabetes.
Advise the patient to increase physical activity, particularly aerobic exercise.	Exercise decreases blood glucose levels as the cells’ demand for glucose (energy) increases with physical activity.
Inform the patient that the blood glucose levels may gradually return to normal once the steroid dose is tapered down and stopped.	To provide reassurance to the patient and carer that blood glucose concentrations may become normal after steroid therapy.

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Nursing Care Plans for Unstable Blood Glucose Level: Nursing Care Plan 3- Diagnosis: Hypoglycemia

Related to non-adherence to the therapeutic regimen for diabetes

Desired Outcome

The patient will demonstrate adherence to the diabetes regimen as evidenced by a reduction to less than 3 episodes of hypoglycemic episodes a week.

Intervention	Rationale
Assess the patient’s blood sugar diary readings with a focus on the following: The number of hypoglycemic episodes The number of hyperglycemic episodes	The patient’s blood sugar levels give healthcare workers an idea of the patient’s activities and practices surrounding his/her diabetes. To begin with, signifying the number of times the patient tests his/her blood sugar level. Also, the number of hypoglycemia or hyperglycemia can indicate the number of times the patient may have missed his/her medications. The patient’s diary can also give information if his/her hypoglycemic episodes were treated properly and if there is a pattern as to when the abnormal readings occur.
Assess and record the patient’s diabetes medications and other medications.	Patients with diabetes require a regular review of their diabetes medications, including any other medications for other conditions. This allows for the assessment of the appropriateness of medications to manage the patient’s diabetes and blood glucose levels. Other medications are also recorded and reviewed to ensure no untoward drug interactions occur. Also, other medications can affect blood sugar levels.
Assess the patient’s understanding of their diabetes management.	Diabetes can occur at any age. A thorough understanding of the condition allows for a better prognosis and management of the disease. Lack of understanding of the disease is associated with reduced commitment to the treatment regime leading to unstable blood glucose levels.
Explore the patient’s practices in hypoglycemia management.	Hypoglycemia can lead to serious complications such as hypoglycemic coma if left untreated. It is recommended that it is treated with 10-20g of quick-acting carbohydrate followed by a long-acting carbohydrate drink or food.
Ask for any concerns regarding his/her medication regime, injection sites and techniques, and anything related to his/her condition.	Diabetes is a lifelong condition. Anxiety and stress are commonly associated with the disease. Discussing concerns with the patient can help identify the possible cause or causes of non-compliance to the treatment regime.
Assess the patient’s injection techniques, injection sites, and understanding of the signs and symptoms of hypoglycemia.	Hypoglycemia is caused by missed medications and improper insulin injection techniques, and injecting insulin on lipohypertrophy. Also, the inability to recognize the symptoms of hypoglycemia prevents proper treatment of the condition.
Discuss the importance of adhering to the prescribed treatment regime in maintaining a normal blood sugar level.	A discussion of the importance of the disease process and the compliance to the prescribed medication regime using easy-to-understand words can help the patient realize what he/she can do to improve his/her general control.

Nursing Care Plans for Unstable Blood Glucose Level: Nursing Care Plan 4- Diagnosis: Gestational Diabetes

Related to stress secondary to gestational diabetes mellitus

Desired Outcome

The patient will demonstrate understanding of the disease process and the importance of adhering to the treatment plan as evidenced by an increased frequency in blood sugar monitoring.

Intervention	Rationale
Assess the patient’s understanding of gestational diabetes. Also, include the assessment of whether the patient has a history of diabetes prior to pregnancy.	Gestational diabetes can occur in women without a history of diabetes pre-pregnancy. In these cases, the patients’ knowledge of the condition can be very little.
Discuss any concerns that the patient may have related to her condition.	Pregnancy can be different for everyone. Anxiety and stress are quite common, and pregnant women will usually have a lot of questions. Taking time to discuss these concerns can help identify the areas that need further teaching and discussion.
Assess the patient’s ability to test blood sugar levels.	For women without a history of diabetes, testing can be tricky and difficult. Also, some women are needle-phobic; hence they only rely on other people to do the testing for them. In the absence of their help, testing may not be possible for the patients to do on their own.
Discuss gestational diabetes with the patient in simple terms.	A thorough discussion of the patient’s condition can help improve her understanding of the disease and the importance of adhering to the treatment plan. Include possible complications of the disease to the patient and the unborn child.
Encourage the patient to record or diary her blood sugar readings, including the date and time the readings were taken.	A blood sugar diary is a helpful way of reminding women to regularly check their blood sugar levels. It also allows self-assessment of how well they are doing or what and when their blood sugar level tends to rise or fall.

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Nursing Care Plans for Unstable Blood Glucose Level: Nursing Care Plan 5- Diagnosis: Pancreatic Cancer

Related to lack of knowledge on insulin management of pancreatic cancer

Desired Outcome

The patient will demonstrate proper use of a blood glucose monitoring machine.

Intervention	Rationale
Assess the patent’s understanding of the condition, including the normal blood sugar levels.	Unstable blood sugar levels may occur as a result of pancreatic disease. In pancreatic cancer, the body’s ability to regulate insulin and glucagon may be affected, leading to dysregulation of blood sugar. The patient may be unaware that this may occur as a complication. A thorough discussion of the disease using easy-to-understand words can help the patient make sense of what is happening in his/her body, further promoting compliance to the management regime. It is also important that the discussion includes the normal values of blood sugar to guide the patient in his/her management.
Assess the patient’s ability to use a blood sugar testing machine.	Glucose testing machines can be different depending on the manufacturer. However, their functions are mostly similar to one another. Demonstrate the proper use of blood sugar testing machine in case the patient is unable to correctly use it.
Discuss the importance of blood sugar testing, keeping a record, and adhering to the prescribed frequency of testing.	The care needs of a patient with pancreatic cancer can change over time. Having a record of the blood sugar readings can help plan the treatment in the future.
Allow time for discussion of concerns and questions related to the condition.	The patient may have plenty of questions related to the condition. Allowing time for questions and answers can improve understanding and compliance with treatment.

Related FAQs

1. Is unstable blood glucose level a nursing diagnosis?

Risk for unstable blood glucose level (00179) is a NANDA International, Inc.(NANDA-I) nursing diagnosis (ND), defined as “Vulnerable to variation in blood glucose/sugar levels from the normal range, which may compromise health” 1 

2. What is unstable blood glucose related to?

Here are some factors or conditions that may lead put patients at risk for an unstable blood glucose: Lack of knowledge on diabetes management or blood glucose management. Developmental level. Imbalance of activity.

3. What is a nursing diagnosis for hypoglycemia?

Nursing Diagnosis: Unstable Blood Glucose Level related to insufficient checking of blood sugar levels and lack of compliance to proper diabetes management secondary to hypoglycemia as evidenced by fatigue and tremors.

4. What are nursing interventions for hypoglycemia?

Severe hypoglycemia can be treated with intravenous (IV) dextrose followed by infusion of glucose. For conscious patients able to take oral (PO) medications, readily absorbable carbohydrate sources (such as fruit juice) should be given.

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