Note: Frequency of blood glucose monitoring is determined by the type of insulin regimen and health status of the patient.
Lab tests: Periodic postprandial blood glucose, and HbA1C. Test urine for ketones in new, unstable, and type 1 diabetes; if patient has lost weight, exercises vigorously, or has an illness; whenever blood glucose is substantially elevated.
Notify physician promptly for presence of acetone with sugar in the urine; may indicate onset of ketoacidosis. Acetone without sugar in the urine usually signifies insufficient carbohydrate intake.
Monitor for hypoglycemia (see Appendix F) at time of peak action of insulin. Onset of hypoglycemia (blood sugar: 50–40 mg/dL) may be rapid and sudden.
Check BP, I&O ratio, and blood glucose and ketones every hour during treatment for ketoacidosis with IV insulin.
Give patients with severe hypoglycemia glucagon, epinephrine, or IV glucose 10–50%. As soon as patient is fully conscious, give oral carbohydrate (e.g., dilute corn syrup or orange juice with sugar, Gatorade, or Pedialyte) to prevent secondary hypoglycemia.