A client with type 1 diabetes who is difficult to arouse has warm flushed skin and tachycardia. What is the priority action for the nurse?

A client with type 1 diabetes who is difficult to arouse has warm flushed skin and tachycardia. What is the priority action for the nurse?

• A. Give orange juice
• B. Check capillary blood glucose
• C. Prepare for insulin drip
• D. Prepare for 50% dextrose

Answer: (B)

In this situation, the immediate priority is to determine the client’s current glucose status at the bedside. Altered mental status in a person with type 1 diabetes can be caused by dangerous glucose disturbances, and treatment hinges on knowing whether glucose is low, normal, or high. Checking capillary blood glucose is the fastest, most definitive way to guide the next steps and prevents guessing about what to treat first. If the glucose is low, you would treat promptly with appropriate glucose replacement (and IV access as available), rather than starting insulin or giving oral carbohydrates when the patient’s airway protection is uncertain. If the glucose is not low, you would pursue other priorities (such as fluids and insulin therapy in the context of possible diabetic ketoacidosis) after confirming the glucose status. Giving orange juice isn’t ideal when the patient is not fully conscious due to aspiration risk, and starting an insulin drip or preplacing 50% dextrose isn’t appropriate before you know the glucose level and stabilization status.

In this situation, the immediate priority is to determine the client’s current glucose status at the bedside. Altered mental status in a person with type 1 diabetes can be caused by dangerous glucose disturbances, and treatment hinges on knowing whether glucose is low, normal, or high. Checking capillary blood glucose is the fastest, most definitive way to guide the next steps and prevents guessing about what to treat first.

If the glucose is low, you would treat promptly with appropriate glucose replacement (and IV access as available), rather than starting insulin or giving oral carbohydrates when the patient’s airway protection is uncertain. If the glucose is not low, you would pursue other priorities (such as fluids and insulin therapy in the context of possible diabetic ketoacidosis) after confirming the glucose status. Giving orange juice isn’t ideal when the patient is not fully conscious due to aspiration risk, and starting an insulin drip or preplacing 50% dextrose isn’t appropriate before you know the glucose level and stabilization status.