Returning to the case of Mr. J., there are several areas where nursing intervention will be important in helping him remain safely in the community while minimizing his risk of hypoglycemia.
A comprehensive assessment will determine his cur¬rent diabetes knowledge and self-care skills. Evalua¬tion of his understanding of the need for consistent carbohydrate intake and meal planning and of his ability to shop and prepare meals will indicate areas where additional education or support may be needed. Demonstration of glucose level self-monitoring and as¬sessment of Mr. J.’s ability to explain what the results mean will help in identifying areas where review or further instruction may be needed. For example, does Mr. J. understand his pre- and post meal glycemic tar¬gets, how results that fall above or below this range may affect him, and what blood glucose levels indicate hypoglycemic risk? According to the ADA, a one-to-two-hour post-meal target blood glucose level of less than 180 mg/dL is recommended for most people with diabetes.16 The pre-meal blood glucose target has been raised to 80 to 130 mg/dL, according to the most recent ADA standards of diabetes care.16
Again, these recommendations may be adjusted as part of an individualized diabetes care plan. Based on the nurse’s assessment of Mr. J.’s diabetes self-management skills as well as the results of his blood glucose testing, his health care providers may order medication changes to support blood glucose con¬trol while minimizing the risk of hypoglycemia. The nurse will then be integral in helping Mr. J. implement any changes to the diabetes care plan. Assessing both his home environment (including home safety, ade¬quate lighting, and access to cooking facilities) and his social and physical support (such as help with shopping, meal preparation, and medications) will be integral in helping to develop a plan for diabetes care that Mr. J. agrees to and can execute. In addition, if needed, a nurse can provide information about com¬munity resources for ongoing diabetes support or edu¬cation through referral to an outpatient center. Mr. J. needs to understand the signs and symptoms of hypo¬glycemia, and how to recognize and treat them as well as how to prevent them. The nurse, looking at the big picture, may be the critical liaison between Mr. J. and his family and health care providers. Recognizing Mr. J.’s strengths and deficits, and working with Mr. J. to meet his needs, will reduce his risk of future hypo¬glycemic events.