If your patient has an HbA1c of 10 and a blood glucose of 200, it’s time to make a nursing care plan for diabetes. The Centers for Disease Control estimate that 12% of adults in the U.S. have this chronic disease, so you’re likely to encounter it in many clinical settings. Learn more about the types of diabetes and what nurses can do to plan care for these patients.
Nursing care plans are a systematic way to approach patient problems. They’re broken down into the steps of assessment, diagnosis, planning, implementation, and evaluation. For our sample care plans, we’ve selected a few nursing diagnoses to dig into. Find a complete list of diagnoses and nursing interventions on NANDA International.
What Is Diabetes?
Diabetes is an endocrine disorder that results in high glucose levels in the bloodstream. After eating, the body works to break down foods into components that can be used by cells. Glucose is one of these components. But to get glucose into cells, insulin is needed from the pancreas. It acts like a key, allowing glucose inside cells so that it can be used. Without insulin, cells are deprived of glucose even when blood sugar levels are high.
There are three types of diabetes mellitus:
- Type 1: An autoimmune reaction stops insulin production in the pancreas. This is typically diagnosed in children and is idiopathic (no clear cause).
- Type 2: A resistance to insulin that results from high blood glucose levels over time. It is far more common, typically diagnosed in adults, and is preventable if caught early enough in the prediabetes stage.
- Gestational: A resistance to insulin that develops during pregnancy, usually around the 24th week.
One thing that often trips up nursing students is the difference between diabetes mellitus and diabetes insipidus. They sound similar but are completely unrelated. And because diabetes mellitus is much more common, it’s mostly referred to as simply “diabetes.”
Both high and low blood glucose in diabetes can lead to acute and chronic complications. A nursing care plan for diabetes can include ongoing management as well as emergent care. If your diabetic patient is unresponsive, has vitals outside of the normal range, or has an extremely low or high blood glucose, seek help from the rapid response team (RRT).
Clinical Areas Where You Might Need a Nursing Care Plan for Diabetes
Diabetes is prevalent, so you may see it in a broad array of settings, including the following:
- Emergency department (ED or ER)
- Cardiac nursing
- Neurological
- Intensive care (ICU)
- Outpatient medicine
- Community health
- Wound care
- Maternal care (OBGYN)
- Pediatrics
- Med-surg
- Operating room (OR)
- Public health
Nursing Care Plan for Diabetes Type 1
Looking for a sample care plan for a diabetes patient with child-onset diabetes? We break down the care plan for a pediatric patient below.
1. Assessment
Casey is a 7-year-old girl who presents to the emergency department on Halloween. Her parents report that she was repeatedly asking to go to the bathroom and had not felt well enough to continue trick-or-treating. At home, the family took a blood sugar reading, and the machine read “High.”
The nurse assesses the following:
- Vital signs
- Height, weight
- Finger stick blood sugar (FSBS)
- Thirst and hunger drive
- Vision problems
- Sweating
- Dry mouth
- Medical history
2. Diagnosis
The highest-priority nursing diagnoses for Casey include the following:
Unstable blood glucose: Casey’s high FSBS readings reveal an issue with managing glucose in the blood. If unaddressed, high blood glucose can lead to diabetic ketoacidosis (DKA), which is a medical emergency. Thirst (polydipsia) can be a clue for unstable blood glucose, as the kidneys work to move glucose out of the body through urine.
Nursing interventions for unstable blood glucose include:
- Administering sliding scale insulin and/or IV insulin per orders.
- Establishing IV access and administering saline per orders.
- Rechecking FSBS per orders and as needed.
Deficient knowledge base: Casey and her family will need education to understand Casey’s current health status and the new plan of care. Health management for children with diabetes can be challenging, and families need ongoing support.
Some potential nursing interventions include:
- Explaining each intervention to the patient and family.
- Educating on the relevance of thirst and sweating signs as a cue to check FSBS.
- Demonstrating FSBS usage and insulin injections.
3. Planning
Using the diagnoses above, the nurse plans care for Casey. This initial hospital admission will focus on acute stabilization and education, while later follow-up visits will reinforce health management skills.
Planning also includes setting goals of care. Casey’s new care goals include the following:
- FSBS readings will stabilize to within normal limits before the end of stay.
- The patient’s family will verbalize understanding of the FSBS sliding scale.
- The family will demonstrate administering insulin injections to the patient before the end of stay.
4. Implementation
Casey’s nurse establishes IV access, collects labs, and initiates insulin and saline as ordered. During these interventions, the nurse explains each step to Casey and her parents. Upon checking Casey’s FSBS again, the nurse asks the parents to use the glucometer under supervision.
5. Evaluation
Over the next several hours, Casey’s blood sugar stabilizes. Casey and her family ask many questions about her diagnoses and plan of care. They still have significant knowledge gaps around diabetes management, signifying a readiness to speak to the diabetes nurse educator. Having met their initial care goals, the family is transferred to a pediatric unit for further management.
Nursing Care Plan for Type 2 Diabetes
Most diabetes care is delivered in primary care settings, where the focus is on ongoing management and preventing complications. Let’s explore an example of a nursing care plan for diabetes mellitus in a clinic.
1. Assessment
Barry is a 77-year-old male. He has a history of type 2 diabetes, managed with long-acting insulin, and is complaining of a new sore on his toe. His HbA1c is 9. He self-reports that his diet “could be better,” but states that he lives far away from a grocery store, and fast food restaurants are much closer to home.
A nursing assessment for Barry includes:
- Vital signs
- Body mass index (BMI)
- Fasting FSBS
- Thirst and urine output
- Skin integrity
- Monofilament testing
2. Diagnosis
His A1c, coupled with a new wound and his self-report, shows that Barry’s diabetes is not being managed adequately. The nurse prioritizes the following nursing diagnoses:
Imbalanced nutrition: Patients with diabetes experience the effects of high-sugar foods and drinks more acutely than others, so proper nutrition is essential to prevent complications. Certain foods help stabilize blood sugar, while others lead to a greater spike. Patients need to understand the link between the foods they eat and their diabetes to make changes accordingly.
Potential nursing interventions include:
- Referring the patient to a diabetic educator and/or nutritionist.
- Coaching the patient on ways to integrate more healthy food choices.
- Educating on diabetes complications and how unstable blood glucose contributes to worsening life quality.
Impaired skin integrity: People with diabetes are especially at risk for skin issues, especially if blood sugar is not managed properly. High blood sugar damages veins and arteries, making blood perfusion more difficult. Diabetic wounds are inflamed and slow to heal, so patients need to take proper skin care precautions to protect them and promote tissue growth.
Consider these interventions in your nursing care plan for diabetes:
- Educating the patient on proper footwear and heel-cushioning devices.
- Keeping skin clean and dry.
- Referring the patient to podiatry.
- Referring to a wound care clinic.
Risk for infection: Because diabetic wounds are slow to heal, they can get infected easily. Patients with diabetes are more likely to suffer from several types of infections, including skin, gastrointestinal, respiratory, and more, and these infections can progress quickly and dangerously. Prevention and early detection of infection are critical for these patients.
Nursing interventions that may be appropriate include:
- Educating the patient on recognizing early signs of infection.
- Coaching the patient on reducing hyperglycemia to limit infection risk.
- Promoting topical antibacterial use as ordered.
3. Planning
The first priority for Barry’s care is to give him the resources to stabilize his blood glucose. “Risk for” diagnoses are generally a secondary priority, and addressing his blood sugar will help promote good outcomes in his other nursing diagnosis areas.
Barry’s nurse sets the following goals for Barry:
- The patient will demonstrate understanding of how to measure his FSBS, how often he should check, and how to administer his insulin.
- The patient’s A1c will decrease to 7 by the next visit.
- The patient’s wound will heal by the next visit, with no infection present.
4. Implementation
Barry’s nurse uses the teach-back method to show Barry the importance of managing his blood glucose, and coaches him on ways to get more nutritious foods into his diet. The nurse also takes Barry through proper care for his foot sore and advises him to visit the wound clinic for a more thorough plan.
5. Evaluation
On Barry’s follow-up appointment four months later, his A1c is 7. While his foot sore is not fully healed, it does not show signs of worsening or infection. The nurse uses this assessment data to create an updated plan of care for Barry.
Nursing Care Plan for Diabetic Ketoacidosis
Diabetic ketoacidosis is an emergent and life-threatening exacerbation that is most commonly seen in type 1 diabetes. Check out a sample care plan below.
1. Assessment
Katelyn is a 34-year-old woman who presents to the emergency department with frequent urination, nausea, vomiting, abdominal pain, and fatigue. She has a history of type 1 diabetes and reports that she missed her last several insulin doses because she had a respiratory virus. Her FSBS is 300.
The nursing assessment for Katelyn includes:
- Vital signs
- Breathing for Kussmaul respirations (fruity odor to breath)
- Level of consciousness
- Blood glucose levels
- Serum and urine ketones
- ABGs for acidosis
- Electrolytes
- Signs of dehydration
- Intake and output
- Precipitating factors (infection, missed insulin, illness)
2. Diagnosis
Katelyn’s nursing care plan for diabetes is focused on acute, emergent diagnoses:
Deficient fluid volume: Because glucose is unavailable to the cells, the body has looked for energy elsewhere and begun breaking down fat into ketones. Ketones build up in the bloodstream and cause acidosis, which the body tries to correct by shedding fluids. This puts Katelyn at risk for shock due to fluid loss.
Possible nursing interventions for Katelyn include:
- Administering IV fluids as prescribed to restore circulating volume.
- Monitoring intake and output closely.
- Assessing for signs of fluid overload, especially during rapid fluid replacement.
Hyperglycemia: Katelyn’s blood glucose is life-threatening and requires urgent treatment. Patients in DKA most commonly receive intravenous insulin, which provides a steady dose of glucose to cells.
Nursing interventions for hyperglycemia include:
- Administering insulin per orders.
- Checking FSBS frequently.
- Encouraging oral food intake once the patient is stable.
Risk for electrolyte imbalance: Fluid replacement can quickly lead to dilution of electrolytes, particularly potassium, which can impact the cerebrovascular system and lead to further complications.
Nursing interventions typically include:
- Monitoring serum potassium levels frequently.
- Administering potassium replacement as ordered.
- Monitoring cardiac rhythm for dysrhythmias associated with potassium imbalance.
3. Planning
Katelyn’s nurse plans the following goals for her:
- The patient will achieve adequate hydration as evidenced by stable vital signs and improved urine output.
- The patient will maintain adequate metabolic balance, with decreasing blood glucose and resolution of ketosis.
4. Implementation
Katelyn’s nurse initiates IV access, begins fluid resuscitation, and then starts a continuous insulin infusion. Once ordered, the nurse collects blood samples to determine electrolyte balances and administers replacements per protocol. Katelyn is placed on continuous telemetry monitoring to watch her heart rate and rhythm.
5. Evaluation
The next day, Katelyn’s vital signs have stabilized, and her blood glucose is 120. Her latest blood test shows no ketones, and her blood acidosis has corrected. Her electrolytes are within normal limits. She verbalizes relief at feeling better and asks for a visit with the diabetic educator to make a plan to prevent DKA in the future.
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