Increased confusion r/t hypoglycemic episode?

Esme12, ASN, BSN, RN · Dec 31, 2011

The elderly can display altered mental status with any disturbances to their routine. Without know what meds she takes for her diabetes it is impossible to know when the meds are peaking and if they need to be changed. A UTI is also a common source for making the system go out of whack and can cause confusion and disturbance of blood sugars, although more commonly hyperglycemia.

I would make an educated guess that there is an irregularity to the administration to her diabetes meds and she is peaking at night causing her to have these hypoglycemic episodes from coma to agitation and combativeness. Maybe the evening people are running a little behind in giving their evening meds, or maybe she is refusing until late....my guess would be to look at the times of her meds and if there has been any changes. I would persue the UA and maybe just try to do a "clean catch" with a hat in the bathroom. Let the MD know of your thoughts. :)

CapeCodMermaid, RN · Dec 31, 2011

I have a resident that went into a diabetic coma Wednesday night around 12 MN. Couldn't bring up the sugar ourselves so we sent out to the ER. They gave her a push of Dextrose and she came back fine as can be. Thursday night when I got to work at 10 PM, it was reported that resident was displaying increased confusion throughout the day. I spoke to the resident at around 10:30 and she seemed ok. Got an accucheck=79. She then ate a whole pb&j sandwich. She got into bed and was sleeping well. Come 2 AM, she wakes up VERY agitated. Refusing to stay in bed, refusing PO fluids, refusing accucheck, wheeling herself around the building and refusing to let us redirect her, being VERY combative and VERY confused. She kept on and on about her husband who died years ago. She stated he was here earlier in the day and that I was the one who killed him and I was lying to her about where I buried him. She refused her 5 am accucheck. I'm just trying to figure out if her hypoglycemic episode can somehow be linked to this delirium? It was also reported to me that she was a little more confused than normal the whole day before the hypogl. episode occured. I did get an order for a u/a but I wasn't able to get urine r/t her being uncooperative and there was NO WAY I would be able to do an i&O on her. Any insight?

I've seen many people become extremely confused when their blood sugars are too low. I worked with a diabetic nurse and we all knew when her sugar was falling because she would start to swear a blue streak. I've had residents present as psychotic when it was a problem with their blood sugars. Of course in the elderly there are many reasons for confusion--UTI, dehydration, dementia....keeping your resident well hydrated with stable sugars might help.

AZMOMO2 · Jan 5, 2012

Usually there can be significant agitation with low blood sugar. Coma could have caused some oxygen deprivation at some point which could have contributed to the episode.

Sometimes you have to dodge a bullet and get back-up to check the sugar whether they want you to or not even when they are not in their right mind. I have had to have someone distract a resident, poke , run and comeback and scoop up the blood as it started to drip to get a sample.

I would have checked it regardless especially when there was such a recent hypoglycemic incident. There could be some underlying reason why the sugars of a normally controlled resident have started to become irregular. Sometimes it actually is a s/s of an active infection.