F5 · Unsteady blood sugar
Risk ⚠ URGENT Food and fluids
Definition
Blood sugar may swing too high or too low because of illness, diet, or medicine.- Diabetes
- insulin or tablets
- skipped meals
- infection
- steroids
- Shaking, sweating, hunger (low sugar)
- thirst and frequent urination (high sugar)
- unusual readings
📋 Scenario
A patient with diabetes has taken insulin before lunch, but lunch is late and she has just had a chest infection.
Subjective (S): "I took my insulin but lunch has not come yet."
Objective (O): Blood sugar 5.2 mmol/L before lunch; insulin given 30 minutes ago; lunch delayed; recent infection; no sweating or shaking.
Assessment tools for this scenario: CP-FLUID Fluid Balance & Nutrition Score CP-INFECT Infection Check
Validated scales to consider: MUST, fluid chart, glucose, qSOFA / sepsis screen
**CarePath diagnosis:** Unsteady blood sugar related to insulin, a delayed meal and infection (risk factors); no signs of the problem are present yet.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Check blood sugar before meals and if symptoms appear. | Checking before meals and when symptoms appear finds high or low sugar early, before harm occurs. |
| Call the kitchen and give a snack if the meal is late. | Insulin keeps working whether or not food arrives, so a late meal risks low sugar. A snack covers the gap. |
| Treat blood sugar below 4 mmol/L at once per protocol and recheck in 15 minutes. | Blood sugar below 4 mmol/L can quickly cause confusion or loss of consciousness. Fast sugar corrects it and rechecking confirms it worked. |
| Teach the warning signs of low and high sugar. | Knowing the signs, such as shaking, sweating or thirst, lets her act early. |
| Record readings. | Records show patterns, which helps the doctor adjust insulin and meal timing. |
**Expected outcomes**
- Blood sugar stays in the doctor's target range with no readings below 4 mmol/L.
- Patient states warning signs and how to treat them.
- Meals matched to insulin timing.
**Linking the data to the diagnosis**
This is a risk statement: the blood sugar has not become unsafe yet. The patient has diabetes, took insulin 30 minutes ago, lunch is delayed and she has just had a chest infection. Blood sugar is 5.2 mmol/L before lunch, and she has no sweating or shaking. She says lunch has not come yet. The diagnosis rests on these risk factors. It is urgent because a fall below 4 mmol/L needs treatment at once, so help is called first if it happens. The plan aims for sugar in the doctor's range with no readings below 4 mmol/L, warning signs stated by the patient, and meals matched to insulin timing.
CarePath diagnosis
Unsteady blood sugar related to insulin, a delayed meal and infection (risk factors); no signs of the problem are present yet.
Interventions and rationale
Listed in priority order — for urgent statements the first action is to get help.
| Intervention | Rationale |
|---|---|
| 1. Check blood sugar before meals and if symptoms appear. | Checking before meals and when symptoms appear finds high or low sugar early, before harm occurs. |
| 2. Call the kitchen and give a snack if the meal is late. | Insulin keeps working whether or not food arrives, so a late meal risks low sugar. A snack covers the gap. |
| 3. Treat blood sugar below 4 mmol/L at once per protocol and recheck in 15 minutes. | Blood sugar below 4 mmol/L can quickly cause confusion or loss of consciousness. Fast sugar corrects it and rechecking confirms it worked. |
| 4. Teach the warning signs of low and high sugar. | Knowing the signs, such as shaking, sweating or thirst, lets her act early. |
| 5. Record readings. | Records show patterns, which helps the doctor adjust insulin and meal timing. |
Expected outcomes
- Blood sugar stays in the doctor's target range with no readings below 4 mmol/L.
- Patient states warning signs and how to treat them.
- Meals matched to insulin timing.
Linking the data to the diagnosis
This is a risk statement: the blood sugar has not become unsafe yet. The patient has diabetes, took insulin 30 minutes ago, lunch is delayed and she has just had a chest infection. Blood sugar is 5.2 mmol/L before lunch, and she has no sweating or shaking. She says lunch has not come yet. The diagnosis rests on these risk factors. It is urgent because a fall below 4 mmol/L needs treatment at once, so help is called first if it happens. The plan aims for sugar in the doctor's range with no readings below 4 mmol/L, warning signs stated by the patient, and meals matched to insulin timing.