An alert diabetic patient has a blood glucose of 55 mg/dL (3.1 mmol/L) and is symptomatic. What is the first appropriate nursing intervention?

Administer 15 grams of fast-acting carbohydrate and recheck glucose in 15 minutes.. Conscious hypoglycemia is treated with 15 grams of fast-acting carbohydrate followed by glucose recheck in 15 minutes—the Rule of 15—before considering further treatment or complex snacks.

Which finding distinguishes diabetic ketoacidosis from hyperosmolar hyperglycemic state?

DKA typically presents with ketosis and Kussmaul respirations; HHS has profound hyperglycemia and dehydration with minimal ketosis.. DKA features ketosis, acidosis, and Kussmaul breathing—common in type 1; HHS shows extreme hyperglycemia and osmolar dehydration with little ketosis—often in type 2—both need fluids and insulin with careful potassium monitoring.

A patient on long-term prednisone abruptly stops the drug. Which complication should the nurse monitor for?

Adrenal crisis with hypotension, weakness, and electrolyte disturbances due to insufficient cortisol.. Abrupt cessation of chronic corticosteroids can precipitate adrenal crisis—hypotension, fatigue, nausea, and electrolyte abnormalities—because the hypothalamic-pituitary-adrenal axis is suppressed and cannot mount a stress response.

Endocrine and Diabetes Care — Free Study Guide 2026

Quick Answer: SNLE endocrine items emphasize type 1 and type 2 diabetes crises (hypoglycemia, DKA, HHS), insulin safety, thyroid storm and myxedema coma recognition, and adrenal insufficiency—critical in Saudi Arabia where diabetes prevalence is among the highest globally.

Endocrine and Diabetes Care

Diabetes management spans outpatient primary care and ICU admissions. SNLE tests blood glucose interpretation, insulin types, sick-day rules, and foot care teaching. Ramadan fasting items may appear—coordinate medication timing without withholding critical insulin.

Hypoglycemia versus Hyperglycemia

Condition	Glucose	Signs	First nurse action
Hypoglycemia	<70 mg/dL (3.9 mmol/L)	Sweating, tremor, confusion	15 g fast carb if alert, recheck 15 min
DKA	Very high, ketones	Kussmaul breathing, fruity breath	Fluids, insulin protocol, K+ monitor
HHS	Extreme high, no ketones	Profound dehydration, AMS	Slow fluids, insulin, watch osmolality

Rule of 15 for hypoglycemia: 15 g glucose, recheck in 15 minutes, repeat if needed, complex snack once stable.

Insulin Types

Insulin	Onset	Peak	Duration
Lispro/Aspart	15 min	1–2 hr	3–5 hr
NPH	1–2 hr	4–12 hr	12–24 hr
Glargine	1–2 hr	Minimal peak	~24 hr

Never mix glargine with others in same syringe. Rotate injection sites; lipohypertrophy impairs absorption.

DKA Nursing Priorities

ABC, IV fluids (isotonic first), insulin infusion per protocol, potassium replacement when urine output adequate—insulin drives K+ intracellularly. Monitor glucose hourly initially, avoid dropping glucose faster than 50–75 mg/dL per hour per protocol.

Thyroid Extremes

Thyroid storm: fever, tachycardia, agitation in hyperthyroid patient—cooling, beta-blocker per order, iodine after thionamide per protocol.

Myxedema coma: hypothermia, bradycardia, hypoventilation—gentle rewarming, ventilatory support, levothyroxine per ICU protocol.

Adrenal Crisis

Hypotension, hyperkalemia, hyponatremia in patient on chronic steroids or abrupt steroid stop—stress-dose hydrocortisone per order; SNLE trap is missing steroid taper education.

Foot Care and Complications

Daily foot inspection, proper footwear, nail care by professional, report wounds early—prevents amputation in neuropathic patients common in Saudi diabetes population.

Ramadan Considerations

Pre-Ramadan medical review; adjust oral agents and insulin timing; break fast if hypoglycemia or hyperglycemia crisis—patient safety overrides fasting when medically indicated.

Worked Scenario

Type 1 patient NPO for surgery, morning glargine held per order but rapid-acting given incorrectly. Glucose 52 mg/dL, unconscious. IV dextrose or glucagon per protocol; do not oral feed unconscious patient.

Traps

Giving insulin before confirming blood glucose
Forgetting K+ in DKA when insulin started
Misidentifying HHS as DKA (ketones absent in HHS)

Final Check

Contrast DKA and HHS, state Rule of 15, and list one Ramadan safety teaching point for insulin-dependent patients.

SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.