Hyperglycemia Nursing Diagnosis & Care Plan: Symptoms, Interventions & Management – devshopsimplenursing

Hyperglycemia Nursing Diagnosis & Care Plan

Amanda Thomas Headshot
By Amanda Thomas
Updated On May 2025
Medically Reviewed by:
Angela Slater FNP, RN
Why trust SimpleNursing
Featured Image

Jump to Sections

When blood sugar spikes, the body sends out some warning signs: constant thirst, frequent bathroom runs, and fatigue. 

Whether it’s missed meds, stress, or that carb-heavy meal, something’s throwing glucose regulation off track. A proper hyperglycemia nursing diagnosis helps catch the issue early and kickstart the right interventions before complications occur.

What is Hyperglycemia? 

Hyperglycemia involves elevated blood glucose levels, often associated with diabetes mellitus.

It occurs when the body either can’t produce enough insulin or can’t effectively use the insulin it produces, leading to high blood sugar. Immediate management is important to prevent acute complications such as diabetic ketoacidosis (DKA) and long-term complications like cardiovascular disease. 

Definition and Pathophysiology 

Hyperglycemia happens when blood glucose levels are above the normal range, typically:

  • Fasting blood glucose (FBG): > 126 milligrams per deciliter (mg/dL) 
  • Postprandial (after eating) glucose: > 180 mg/dL 

Pathophysiologically, hyperglycemia occurs due to: 

  • Insulin resistance (Type 2 diabetes) 
  • Insufficient insulin production (Type 1 diabetes) 
  • Increased gluconeogenesis due to stress hormones like cortisol and adrenaline

Normal vs. Elevated Blood Glucose Levels 

  • Normal fasting glucose: 70-100 mg/dL 
  • Normal postprandial glucose: < 140 mg/dL 
  • Prediabetes: Fasting glucose 100-125 mg/dL 
  • Diabetes: Fasting glucose ≥ 126 mg/dL on two separate occasions 

Differences Between Hyperglycemia vs. Hypoglycemia 

Knowing the difference between low and high blood sugar is critical for safe patient care. 

Whether creating a nursing care plan on hyperglycemia or identifying the right nursing diagnosis for hypoglycemia, recognizing the symptoms on both ends of the spectrum can make all the difference in treatment and outcomes.

  • Hyperglycemia: High blood glucose (>180 mg/dL); symptoms include increased thirst, urination, and fatigue
  • Hypoglycemia: Low blood glucose (<70 mg/dL); symptoms include sweating, shaking, confusion, and irritability
Feature Hyperglycemia Hypoglycemia
Glucose level >180 mg/dL (after eating) <70 mg/dL
Key symptoms Thirst, frequent urination, fatigue Sweating, shaking, confusion, irritability
Onset Gradual Sudden
Breath odor Fruity (in severe cases like DKA) Normal
Skin Warm and dry Cool and clammy
Mental status Drowsy or lethargic in severe cases Confused, irritable, or anxious

Causes of Hyperglycemia (Related To) 

Blood sugar doesn’t spike out of nowhere. There’s always a reason behind the rise. 

Whether it’s stress, skipped meds, or that triple-scoop sundae, understanding what’s causing hyperglycemia is key to choosing the right nursing diagnosis and intervention. 

Here are the most common culprits nurses should watch for. 

Uncontrolled Diabetes

  • Type 1 diabetes: Inadequate insulin production due to autoimmune destruction of pancreatic beta cells
  • Type 2 diabetes: Relative insulin deficiency and insulin resistance 

Stress Response

  • Illness, surgery, or infection can trigger the release of stress hormones (cortisol, epinephrine), which increase blood glucose levels. 

Poor Medication Adherence 

  • Missed insulin doses or oral hypoglycemic agents lead to poor glycemic control. 
  • Incorrect insulin administration or improper dosage adjustments may result in blood glucose fluctuations and increased risk of complications.

Corticosteroid Use

  • Steroids (e.g., prednisone) increase gluconeogenesis and insulin resistance, leading to hyperglycemia. 

High-carbohydrate Intake

  • This involves excessive intake of refined carbohydrates and sugars without appropriate insulin or medication coverage. 

Signs and Symptoms of Hyperglycemia (As Evidenced By) 

Spotting these signs and symptoms early can help prevent serious complications.

Increased Thirst and Urination 

  • Polydipsia: Excessive thirst due to dehydration from osmotic diuresis 
  • Polyuria: Frequent urination due to high glucose levels drawing water into the urine 

Fatigue and Weakness

  • Reduced energy levels due to the body’s inability to use glucose effectively 

Blurred Vision

  • Caused by fluid shifts in the eye lens due to high blood glucose levels 

Fruity Breath Odor (DKA risk)

  • The presence of ketones leads to a fruity, acetone-like breath odor

Slow-healing Wounds and Recurrent Infections

  • Chronic hyperglycemia impairs the immune response and reduces circulation, which leads to delayed wound healing and frequent infections.

Risk Factors for Hyperglycemia 

Several factors can throw off blood glucose control and increase the risk for hyperglycemia. 

Below are some of the most common contributors to watch for.

Diabetes Mellitus (Types 1 and 2)

  • People living with Type 1 or Type 2 diabetes are at inherent risk for hyperglycemia due to insulin deficiency or resistance.

Sedentary Lifestyle

  • Not getting enough physical activity contributes to insulin resistance and weight gain. 

High Stress Levels

  • High levels of stress increase cortisol and adrenaline, which raises blood sugar. 

Poor Diet or Non-compliance with Diabetic Management 

  • Consuming high amounts of refined carbohydrates and sugary foods may lead to elevated blood glucose levels.
  • Failing to adhere to prescribed medications or insulin regimens can disrupt blood sugar control and contribute to hyperglycemia.

Medications that Elevate Blood Sugar 

  • Steroids increase gluconeogenesis. 
  • Beta-blockers may mask hypoglycemia symptoms, leading to hyperglycemia. 

Nursing Assessment for Hyperglycemia 

Catching hyperglycemia early starts with a solid nursing assessment. 

From patient-reported symptoms to lab values and vital signs, every data point helps paint the full blood sugar picture.

Objective vs. Subjective Data Collection 

  • Subjective: Patient-reported symptoms such as thirst, fatigue, and frequent urination.
  • Objective: Blood glucose readings, vital signs, and lab results. 

Vital sign monitoring 

Capillary Blood Glucose Monitoring 

  • Definition: Capillary blood glucose (CBG) monitoring involves obtaining a small blood sample from the fingertip using a lancet and measuring glucose levels using a glucometer. 
  • Purpose: To provide real-time blood glucose readings for immediate decision-making. 
  • Frequency of monitoring: 
    • For Type 1 diabetes: Before meals, at bedtime, and before exercise or driving 
    • For Type 2 diabetes: At least once daily or as recommended, especially before meals and at bedtime 
  • During illness or DKA risk: Every two to four hours to monitor for hyperglycemic emergencies 
  • Target range: 
    • Fasting glucose: 70-130 mg/dL
    • Postprandial glucose (one to two hours after a meal): <180 mg/dL
    • Bedtime glucose: 100-140 mg/dL 

Venous Blood Glucose Monitoring 

  • Definition: Venous blood glucose testing involves drawing blood from a vein (usually from the arm) and analyzing it in a laboratory or point-of-care testing device. 
  • When to use:
    • During hospital admission, especially for hyperglycemic emergencies.
    • When capillary glucose readings are inconsistent with clinical symptoms. 
    • To confirm severe hyperglycemia (>300 mg/dL) or hypoglycemia (<70 mg/dL). 

Blood Pressure and Heart Rate Monitoring 

Importance in Hyperglycemia 

Blood pressure (BP) and heart rate (HR) are crucial in assessing the hemodynamic status of patients with hyperglycemia, especially those at risk for DKA or HHS. 

Hyperglycemia can cause dehydration due to osmotic diuresis, leading to:

BP and HR changes also provide early signs of cardiovascular complications related to diabetes, such as hypertension, arrhythmias, and autonomic neuropathy. 

Blood Pressure Monitoring

  • Frequency:
    • Every four hours in hospitalized patients with hyperglycemia
    • More frequently (every one to two hours) in patients with DKA or HHS. 
  • Target range: 
    • Patients diagnosed with diabetes: < 140/90 millimeters of mercury (mmHg) as recommended by the American Diabetes Association. 

Heart Rate Monitoring 

  • Frequency: 
    • Every four hours or more frequently in critically ill patients. 
  • Target range: 
    • Normal: 60-100 beats per minute (bpm) 
  • Tachycardia (>100 bpm): 
    • Indicative of dehydration and hypovolemia due to osmotic diuresis
    • Early sign of DKA or HHS 
    • Can indicate pain, anxiety, or autonomic neuropathy in diabetic patients 

Lab Tests 

  • FBG: To assess baseline glucose control
  • Random blood glucose: To diagnose hyperglycemia in symptomatic patients
  • Hemoglobin A1c (HbA1c): To assess long-term glucose control (two to three months average)
  • Serum ketones: To detect DKA — beta-hydroxybutyrate > 3 millimoles per liter (mmol/L)
  • Blood pressure and heart rate for signs of dehydration or DKA. 

Patient History

  • Dietary habits: Intake of carbohydrates and adherence to dietary recommendations 
  • Medication adherence: Consistency and accuracy in insulin or oral medication administration 
  • Physical activity level: Frequency and intensity of exercise 

Nursing Diagnosis for Hyperglycemia 

These nursing diagnoses help connect the dots between the root causes and the clinical signs that show up at the bedside.

Imbalanced Nutrition: More than Body Requirements Related to Excessive Caloric Intake 

Related To: 

  • Frequent consumption of sugary foods and refined carbohydrates 
  • Sedentary lifestyle with limited physical activity 
  • Emotional eating due to anxiety, depression, or stress
  • Lack of knowledge about portion control and balanced nutrition 
  • Insulin resistance leading to ineffective glucose use in Type 2 diabetes 

As Evidenced By: 

  • Elevated blood glucose levels >180 mg/dL postprandial
  • Increased body mass index (BMI) ≥ 25
  • Weight gain or inability to lose weight
  • Elevated hemoglobin A1c (HbA1c) >7%
  • Hyperlipidemia (elevated cholesterol and triglycerides)
  • Frequent hyperglycemic symptoms (thirst, frequent urination, fatigue) 

Risk for Unstable Blood Glucose Related to Insufficient Insulin Therapy 

Related To: 

  • Insufficient insulin therapy or incorrect insulin administration 
  • Inconsistent medication adherence (missed doses or improper timing) 
  • Irregular dietary intake and inconsistent carbohydrate consumption 
  • Physical inactivity or sudden increase in exercise without medication adjustment 
  • Use of medications that impact glucose levels (e.g., corticosteroids, beta-blockers) 
  • Acute illness or stress increasing insulin resistance and gluconeogenesis 

As Evidenced By: 

  • Fluctuating blood glucose levels with frequent hyperglycemia (>250 mg/dL) or hypoglycemia (<70 mg/dL) 
  • Symptoms of hypoglycemia (sweating, confusion, irritability) or hyperglycemia (thirst, fatigue) 
  • Elevated HbA1c, indicating poor glycemic control over two to three months
  • Frequent hospitalizations or emergency visits due to uncontrolled diabetes 

Deficient Knowledge Related to Diabetes Self-Management 

Related To: 

  • Newly diagnosed Type 1 or 2 diabetes 
  • Insufficient education about diabetes management and prevention
  • Misconceptions about insulin therapy or oral antidiabetic medications
  • Inadequate knowledge about carbohydrate counting and portion control
  • Limited understanding of why regular blood glucose monitoring is important 

As Evidenced By: 

  • Inconsistent blood glucose self-monitoring
  • Non-adherence to prescribed medication regimen 
  • Frequent hyperglycemia or hypoglycemia episodes 
  • Inability to recognize symptoms of hyperglycemia, hypoglycemia, or DKA 
  • Poor dietary choices leading to glucose fluctuations 

Ineffective Health Maintenance Related to Non-adherence to Diabetic Regimen 

Related To: 

  • Non-adherence to diabetic regimen, including diet, exercise, and medication 
  • Lack of motivation or support systems for lifestyle changes 
  • Emotional barriers, including denial, anxiety, or depression 
  • Cultural or socioeconomic factors impacting dietary choices 

As Evidenced By: 

  • Poor glycemic control with frequent hyperglycemic episodes 
  • Lack of regular physical activity or exercise 
  • Inconsistent follow-up appointments and poor disease monitoring 
  • Recurrent complications such as diabetic neuropathy, retinopathy, or nephropathy 

Risk for Fluid Volume Deficit Related to Osmotic Diuresis 

Related To: 

  • Hyperglycemia causing osmotic diuresis and polyuria
  • Inadequate fluid intake due to nausea or altered mental status
  • Vomiting or diarrhea during illness or DKA 
  • Electrolyte imbalance leading to dehydration and hypovolemia 

As Evidenced By:

  • Increased urine output (polyuria) and excessive thirst (polydipsia) 
  • Signs of dehydration: Dry mucous membranes, tachycardia, and hypotension 
  • Altered mental status (confusion, lethargy) due to dehydration and hyperosmolarity 
  • Laboratory findings: Elevated serum osmolality, hypernatremia, and high blood glucose 

Expected Outcomes & Nursing Goals 

Effective hyperglycemia management starts with clear, measurable goals. 

From stabilizing blood sugar to preventing complications, these outcomes guide the care plan.

Maintain Blood Glucose Levels Within Target Range 

  • Fasting Blood Glucose: 70-130 mg/dL 
  • Postprandial Blood Glucose: <180 mg/dL 
  • HbA1c: < 7% for adults, individualized for older adult or high-risk patients

Prevent Complications 

  • Prevent acute complications like DKA and HHS. 
  • Prevent long-term complications, including neuropathy, nephropathy, retinopathy, and cardiovascular disease. 

Improve Patient Knowledge About Diabetes Management 

  • Educate on carbohydrate counting, portion control, and meal planning. 
  • Ensure understanding of insulin administration techniques and oral medication adherence. 
  • Teach patients to recognize early symptoms of hyperglycemia and hypoglycemia. 

Establish a Consistent Medication and Dietary Regimen 

  • Achieve consistent blood glucose control with scheduled insulin or oral antidiabetic medications. 
  • Develop a personalized meal plan to maintain balanced nutrition and glycemic control. 
  • Encourage regular physical activity to manage weight and improve insulin sensitivity. 

Nursing Interventions for Hyperglycemia 

These nursing interventions focus on lowering blood glucose, preventing complications, and supporting long-term management.

Blood Glucose Monitoring 

Routine Capillary Blood Glucose Checks 

  • Before meals, at bedtime, and during symptoms of hyperglycemia or hypoglycemia 
  • Every two to four hours during illness, DKA, or unstable blood glucose levels 

Continuous Glucose Monitoring

  • For patients with frequent hypoglycemia or unstable diabetes 

Record and Report Findings

  • Document readings, trends, and symptoms for healthcare provider review 

Insulin Administration

Adjusting Insulin Therapy as Needed: 

  • Administer scheduled or sliding scale insulin based on blood glucose readings. 
  • Adjust insulin doses during illness, stress, or dietary changes. 
  • Educate on proper insulin injection techniques and site rotation to avoid lipodystrophy. 

Fluid Replacement

Managing Dehydration from Osmotic Diuresis: 

  • Implement oral rehydration with electrolyte-balanced fluids for mild dehydration. 
  • Provide IV fluids (e.g., isotonic saline) for moderate to severe dehydration or DKA. 
  • Monitor urine output, electrolytes, and vital signs to assess hydration status. 

Dietary Education

Teaching Carbohydrate Counting and Portion Control 

  • Educate on the glycemic index (GI) and choosing low GI foods. 
  • Teach consistent carbohydrate intake to stabilize blood glucose levels. 
  • Collaborate with a dietitian for personalized meal planning. 

Physical Activity Promotion: Encouraging Regular Exercise to Lower Blood Sugar 

  • Aerobic exercise: Aim for at least 150 minutes of moderate-intensity activity each week (e.g., walking, cycling). 
  • Resistance training: Train twice weekly to enhance insulin sensitivity and muscle mass. 
  • Educate on monitoring blood glucose before and after exercise to prevent hypoglycemia. 

Hyperglycemia Nursing Care Plan Examples 

A strong nursing care plan for hyperglycemia starts with understanding what’s throwing blood sugar out of balance, whether it’s poor medication timing, insulin resistance, or lifestyle habits. 

These care plan examples highlight common scenarios and how to address them with the right nursing diagnosis and interventions.

Care Plan #1: Hyperglycemia in Type 2 Diabetes 

Nursing Diagnosis 

Imbalanced Nutrition: More than Body Requirements 
Related To:  
  • Excessive caloric intake and consumption of high-carbohydrate foods 
  • Sedentary lifestyle and lack of physical activity 
  • Insulin resistance associated with metabolic syndrome and obesity
  • Inconsistent medication adherence or improper timing of oral antidiabetic drugs 
As Evidenced By: 
  • Elevated blood glucose levels (>180 mg/dL postprandial) 
  • Increased BMI ≥ 30 
  • Elevated HbA1c (>7%) 
  • Inability to lose weight despite attempts or weight gain

Expected Outcomes 

Short-Term Goals: 
  • Achieve fasting blood glucose levels between 70 and 130 mg/dL within one week. 
  • Maintain postprandial blood glucose < 180 mg/dL. 
  • Understand carbohydrate counting and portion control by the end of education sessions. 
  • Engage in at least 150 minutes of moderate exercise per week. 
Long-Term Goals: 
  • Achieve and maintain a 5% to  10% weight loss within three to six months. 
  • Reduce HbA1c to <7% within three to six months. 
  • Establish a sustainable meal plan to maintain glycemic control and prevent weight gain. 
  • Prevent complications such as neuropathy, retinopathy, and cardiovascular disease. 

Assessment 

Subjective Data
  • Assess dietary patterns, meal frequency, and portion sizes. 
  • Evaluate understanding of carbohydrate counting and glycemic index. 
  • Identify barriers to lifestyle modifications, including cultural or socioeconomic factors. 
Objective Data 
  • Monitor blood glucose levels (fasting, postprandial, and bedtime). 
  • Check HbA1c every three months. 
  • Record weight, BMI, and waist circumference. 
  • Assess vital signs for hypertension and heart rate. 

Interventions 

Dietary Education
  • Educate on carbohydrate counting, portion control, and the glycemic index. 
  • Collaborate with a dietitian to come up with a personalized meal plan. 
  • Encourage nutrient-dense, high-fiber foods to promote satiety and glycemic control. 
Physical Activity Promotion
  • Encourage a minimum of at least 150 minutes of moderate-intensity physical activity weekly. 
  • Suggest activities such as walking, swimming, or cycling. 
  • Educate on the benefits of resistance training twice per week to improve insulin sensitivity. 
Medication Management
  • Educate on the importance of consistent medication adherence. 
  • Monitor for side effects of oral antidiabetic agents (e.g., metformin, sulfonylureas). 
  • Collaborate with the health care provider for medication adjustments. 
Blood Glucose Monitoring 
  • Encourage routine blood glucose checks before meals and at bedtime. 
  • Educate on recognizing symptoms of hyperglycemia and hypoglycemia. 
  • Review and interpret blood glucose logs to identify patterns and trends. 

Care Plan #2: Diabetic Ketoacidosis (DKA) in Type 1 Diabetes 

Nursing Diagnosis 

Risk for Fluid Volume Deficit 
Related To:
  • Osmotic diuresis due to hyperglycemia 
  • Polyuria, vomiting, and dehydration 
  • Insufficient insulin administration leading to ketosis and metabolic acidosis 
As Evidenced By:
  • Polyuria, polydipsia, and signs of dehydration (dry mucous membranes, hypotension) 
  • Fruity breath odor, Kussmaul respirations, and altered mental status 
  • Elevated blood glucose levels (> 300 mg/dL) 
  • Presence of ketones in urine and blood 

Expected Outcomes 

Short-Term Goals 
  • Stabilize blood glucose levels between 140 and 180 mg/dL within 24 to 48 hours. 
  • Correct dehydration and restore fluid balance within 24 hours. 
  • Resolve ketosis and acidosis within 24 to 48 hours. 
  • Prevent complications such as hypokalemia and cerebral edema. 
Long-Term Goals 
  • Maintain blood glucose within the target range to prevent the recurrence of DKA. 
  • Achieve HbA1c < 7.5% for pediatric patients and < 7% for adults. 
  • Educate on insulin administration and sick day management. 

Assessment 

Subjective Data 
  • Assess symptoms of polydipsia, polyuria, nausea, vomiting, and abdominal pain. 
  • Document history of insulin administration, missed doses, or pump failure. 
  • Evaluate for precipitating factors such as infection, illness, or stress. 
Objective Data
  • Blood glucose levels (> 300 mg/dL) and urine ketones 
  • Arterial blood gases showing metabolic acidosis (low pH and bicarbonate) 
  • Electrolytes for potassium, sodium, and chloride imbalances 
  • Vital signs: Tachycardia, hypotension, and Kussmaul respirations 

Interventions 

Fluid Replacement
  • Initiate IV fluids with isotonic saline (0.9% NaCl) to restore volume and perfusion. 
  • Once stabilized, transition to 0.45% NaCl, followed by D5-0.45% NaCl when glucose < 250 mg/dL. 
Insulin Administration
  • Administer continuous IV insulin infusion to reduce blood glucose gradually. 
  • Monitor blood glucose hourly and adjust insulin infusion accordingly. 
  • Transition to subcutaneous insulin once ketosis resolves and oral intake resumes. 
Electrolyte Monitoring and Replacement
  • Monitor potassium levels every two to four hours and replace as needed. 
  • Monitor for signs of hypokalemia (muscle weakness, arrhythmias). 
  • Monitor sodium and phosphate levels and replace them as needed. 
Monitoring and Safety
  • Implement continuous cardiac monitoring to detect potential arrhythmias.
  • Perform neurological checks every one to two hours to monitor for signs of cerebral edema.
  • Measure intake and output to assess fluid balance.

Care Plan #3: Hyperglycemia in a Hospitalized Patient on Steroids 

Nursing Diagnosis 

Risk for Unstable Blood Glucose 
Related To: 
  • Corticosteroid-induced insulin resistance 
  • Increased gluconeogenesis due to corticosteroid therapy 
As Evidenced By: 
  • Elevated blood glucose levels post-steroid administration 
  • Frequent hyperglycemia episodes despite antidiabetic medication 

Expected Outcomes 

  • Maintain blood glucose levels between 140 and 180 mg/dL during hospitalization. 
  • Prevent hyperglycemia-related complications (e.g., infections, delayed wound healing). 
  • Adjust antidiabetic medications to manage corticosteroid-induced hyperglycemia. 

Assessment 

Subjective Data Collection 
Patient History 
  • Review medical history for diabetes (Type 1 or Type 2), prediabetes, or gestational diabetes. 
  • Assess the history of hyperglycemia during previous steroid treatments. 
  • Document comorbidities influencing glucose metabolism, such as obesity, hypertension, cardiovascular disease, or chronic kidney disease. 
Medication History 
  • Record the current corticosteroid regimen, including type, dose, frequency, and duration. 
  • Evaluate other medications impacting blood glucose levels (e.g., beta-blockers, thiazide diuretics). 
  • Assess previous or current use of antidiabetic medications, including insulin, metformin, or sulfonylureas. 
Nutritional Assessment 
  • Review dietary intake, focusing on carbohydrate consumption and meal patterns. 
  • Assess for changes in appetite or eating habits due to corticosteroids (e.g., increased appetite). 
  • Document fluid intake to monitor for dehydration or osmotic diuresis. 
Psychosocial and Lifestyle Assessment: 
  • Identify stressors related to hospitalization, illness, or corticosteroid therapy. 
  • Assess for barriers to diabetes management, including health literacy, financial constraints, or cultural influences on diet. 
  • Determine physical activity levels before hospitalization. 
Symptoms of Hyperglycemia: 
  • Polydipsia: Increased thirst 
  • Polyuria: Frequent urination 
  • Polyphagia: Increased hunger 
  • Fatigue and weakness: Due to the inability to use glucose effectively 
  • Blurred vision: Resulting from fluid shifts in the lens 
  • Delayed wound healing: Indicating impaired immune function 
Objective Data Collection 
Vital Signs 
  • Blood pressure: Monitor for hypertension, which is common with corticosteroid use. 
  • Heart rate: Tachycardia may indicate dehydration or hyperosmolar state. 
  • Respiratory rate and pattern: Assess for signs of metabolic acidosis (e.g., Kussmaul respirations in DKA). 
  • Temperature: Monitor for signs of infection, which can increase insulin resistance. 
Anthropometric Measurements
  • Body weight: Monitor for weight gain due to corticosteroid-induced fluid retention and increased appetite. 
  • BMI: Assess obesity-related insulin resistance. 
  • Waist circumference: Evaluate central adiposity, which correlates with insulin resistance. 
Laboratory Tests 
  • Blood glucose levels: 
    • FBG: Assess baseline glycemic control. 
    • Random blood glucose: Measure for real-time assessment of hyperglycemia. 
    • HbA1c: If not checked in the last three months, measure to evaluate long-term glycemic control. 
  • Electrolytes and renal function: 
    • Serum electrolytes: Monitor sodium, potassium, and chloride. 
    • Serum osmolality: Assess for hyperosmolar state in severe hyperglycemia. 
    • Renal function tests: Measure blood urea nitrogen (BUN) and creatinine to evaluate dehydration or diabetic nephropathy. 
  • Urine tests: 
    • Urine ketones: Measure to assess for ketosis, especially in patients with Type 1 diabetes. 
    • Urine glucose: Monitor for glucosuria due to hyperglycemia. 
    • Urine output and specific gravity: Assess hydration status and osmotic diuresis. 

Interventions 

Blood Glucose Monitoring 
  • Monitor blood glucose every four to six hours during steroid therapy. 
  • Perform postprandial checks to assess post-steroid glucose spikes. 
Medication Adjustments
  • Administer rapid-acting insulin for postprandial glucose control. 
  • Adjust long-acting insulin or oral antidiabetic medications as needed. 
Dietary Education 
  • Teach patients to reduce carbohydrate intake during steroid use. 
  • Collaborate with a dietitian for personalized meal planning. 
Patient Education
  • Educate on the impact of steroids on blood glucose. 
  • Instruct on recognizing and managing hyperglycemia symptoms. 

Preventing Hyperglycemia & Long-Term Complications 

Prevention starts with consistency. 

The following strategies focus on keeping blood sugar in check now and avoiding serious complications down the road.

Strategies for Blood Sugar Control 

Effective blood sugar control requires a comprehensive approach combining lifestyle modifications, medication adherence, and regular monitoring. 

These strategies aim to: 

  • Maintain blood sugar levels within the target range.
  • Reduce the risk of acute complications like DKA and HHS.
  • Prevent long-term complications like cardiovascular disease, nephropathy, neuropathy, and retinopathy.

Importance of Medication Compliance 

Medication compliance is critical for maintaining blood glucose control, preventing complications, and enhancing overall health outcomes. 

Consistent Medication Administration

  • Take insulin and oral antidiabetic agents as prescribed at the same time daily. 
  • Never skip doses, even on “good” glucose days, to maintain consistent blood glucose levels. 

Patient Education and Understanding

  • Educate on the purpose and mechanism of each medication. 
  • Review potential side effects and how to manage them. 
  • Emphasize the importance of adherence to prevent complications like DKA or HHS. 

Strategies to Improve Adherence

  • Use medication organizers, reminders, or mobile apps. 
  • Simplify complex regimens by consulting with health care providers. 
  • Collaborate with pharmacists for medication synchronization. 

Monitoring and Follow-Up

  • Schedule regular follow-up visits to assess adherence and adjust medications. 
  • Monitor HbA1c every three to six months to evaluate long-term glucose control. 

Recognizing Early Warning Signs of Hyperglycemia 

Early recognition of hyperglycemia prevents progression to DKA or HHS. 

Common Symptoms of Hyperglycemia 

  • Polydipsia: Excessive thirst 
  • Polyuria: Frequent urination 
  • Polyphagia: Increased hunger 
  • Weakness and fatigue: Due to the body’s inability to use glucose 
  • Blurred vision: Resulting from fluid shifts in the lens of the eye 
  • Slow-healing wounds: Indicative of impaired immune response 

Symptoms of Severe Hyperglycemia or DKA

  • Nausea and vomiting 
  • Abdominal pain 
  • Fruity breath odor (acetone breath) 
  • Kussmaul respirations (deep or labored breathing) 
  • Confusion, lethargy, or coma 

Patient Education on When to Seek Help: 

  • Blood glucose levels consistently > 300 mg/dL 
  • Presence of ketones in urine or blood 
  • Signs of dehydration (dry mouth, sunken eyes, or rapid heartbeat) 
  • Neurological symptoms (confusion, dizziness, or lethargy) 

Emergency Management

  • Seek emergency care for severe hyperglycemia, dehydration, or altered mental status. 
  • Administer rapid-acting insulin as directed by health care providers. 
  • Initiate fluid intake to prevent dehydration if the patient is alert and able to drink. 

Patient Education & Discharge Planning 

Before discharge, patients need more than a prescription. They need the tools and confidence to manage blood sugar on their own. 

Teaching Self-monitoring of Blood Glucose (SMBG)

Objectives of Self-Monitoring Education 

Understand the Importance of SMBG: 
  • Monitor the effectiveness of diabetes management. 
  • Detect hyperglycemia and hypoglycemia early to prevent complications. 
  • Adjust carbohydrate intake and insulin doses based on blood glucose trends. 
Increase Patient Confidence and Competency: 
  • Promote independence in diabetes management. 
  • Build confidence in recognizing and responding to blood glucose fluctuations. 

Developing an individualized diabetes management plan 

Key Components of a Diabetes Management Plan 

Personalized Blood Glucose Targets

Tailor blood glucose targets based on age, comorbidities, and individual preferences. 

General Targets 
  • Fasting: 70-130 mg/dL 
  • Postprandial: < 180 mg/dL 
  • HbA1c: < 7% (individualized for older adults or high-risk patients)
Medication Management
  • Develop a medication schedule for insulin or oral antidiabetic agents. 
  • Educate on the correct timing, dosage, and administration techniques. 
  • Instruct on-site rotation for insulin injections to prevent lipodystrophy. 
Meal Planning and Nutritional Guidance
  • Implement carbohydrate counting for consistent intake. 
  • Educate on portion control and glycemic index for better glucose regulation. 
  • Include preferred foods to enhance adherence while ensuring balanced nutrition. 
Physical Activity and Exercise
  • Create an exercise plan tailored to fitness level and preferences. 
  • Educate on blood glucose monitoring before and after exercise. 
  • Plan for snack adjustments to prevent exercise-induced hypoglycemia. 
Sick Day Management 
  • Educate on more frequent blood glucose and ketone monitoring during illness. 
  • Advise on maintaining hydration and carbohydrate intake. 
  • Develop an action plan for insulin adjustment during illness. 
Follow-up and Continuous Support 
  • Schedule regular follow-up appointments for HbA1c monitoring and medication adjustments. 
  • Establish open communication channels for questions and concerns. 
  • Encourage participation in diabetes education programs or support groups. 

Guidance on Dietary Modifications 

Core Principles of Dietary Modifications 

Consistent Carbohydrate Intake 

Maintain consistent carbohydrate intake at each meal to stabilize blood glucose. 

General Recommendations 
  • Women: 45-60 grams per meal 
  • Men: 60-75 grams per meal 
Carbohydrate Counting and Glycemic Index Education 
  • Educate on carbohydrate counting to adjust insulin or medication doses. 
  • Choose low glycemic index (GI) foods for gradual glucose release. 
Balanced Nutrition
  • Add healthy fats, complex carbohydrates, and lean proteins. 
  • Increase dietary fiber (25 to 30 grams daily) to improve satiety and glucose control. 
  • Include non-starchy vegetables for essential vitamins and minerals. 
Meal Planning Techniques: 

Use the plate method. 

  • ½ plate of non-starchy vegetables 
  • ¼ plate of lean protein (e.g., chicken, fish, tofu) 
  • ¼ plate of whole grains or starchy vegetables 

Plan snacks and meals at regular intervals to maintain glycemic balance. 

Foods to Limit or Avoid: 
  • Refined carbohydrates: White bread, pastries, sugary cereals 
  • Sugary beverages: Soda, fruit juices, and sweetened teas 
  • Processed foods: Added sugars, High in sodium, and unhealthy fats 
Hydration and Alcohol Consumption: 
  • Encourage adequate water intake (8 to 10 cups daily). 
  • Educate on safe alcohol consumption and its effect on blood glucose. 

Recommended Resources for Hyperglycemia Management 

Effective hyperglycemia management goes beyond the bedside. 

These trusted resources offer extra support for education, tracking, and long-term blood sugar control.

Nursing Care Plan Resources

Keeping It Simple with Blood Sugar Support

Hyperglycemia might seem complex, but management doesn’t have to be. 

With accurate nursing diagnoses, targeted interventions, and support from trusted resources, it becomes easier to:

  • Recognize risks
  • Respond to symptoms
  • Promote better outcomes

Consistent care and patient education go a long way in keeping blood glucose — and complications — in check.

References & Sources 

  1. “Diabetes Discharge Instructions.” Banner Health. Accessed February 26, 2025.
  1. “Discharge Planning for Patients with Diabetes Mellitus.” Nursing Center. Accessed February 28, 2025.
  1. “Discharge Planning for Adults with Diabetes.” Association of British Clinical Diabetologists (ABCD). Accessed February 27, 2025.
  1. “Instituting a Successful Discharge Plan for Patients With Type 2 Diabetes.” National Center for Biotechnology Information (NCBI). Accessed February 26, 2025.
  1. “A Nurse’s Guide to Hyperglycemia.” Nursing CE Central. Accessed February 26, 2025.
  1. “Discharging Patients with Diabetes Safely.” Inpatient Diabetes. Accessed February 26, 2025.
  1. “Management of Diabetes and Hyperglycemia in Hospitalized Patients.” National Center for Biotechnology Information (NCBI). Accessed February 27, 2025.