Resident with hyperglycaemia and high blood pressure

[steernorth]

Hi guys,

Hope you are all well. Im just starting on my journey as a div2, and would love some help. A resident has a bgl of 19.6. She also suffers high blood pressure. Im trying to understand what the best interventions are for this resident. Given I believe that one intervention for hyperglycaemia is to give free fluids, to me this seems contradictory given she also has high blood pressure. If we give free fluids, wont this just increase her blood volume and in turn, contribute to a higher BP? I am showing my ignorance here I know, but would love your guys expert help on how to manage a scenario where someone's BGL is really high and they suffer high BP. This resident is on insulin. Thanks for any help.

Simon

[KatieMI, BSN, MSN, RN]

First of all, it is USA-based forum, and so it would be more convenient to give values in mg/dl, which is between 342 and 360.

Conversion Table for Blood Glucose Monitoring | Joslin Diabetes Center

Second, intervention for elevated blood glucose us primarily diet, meds and insulin, with the dose of insulin being as high as "enough of it to keep glucose within parameters". The concept of "diluting the sugar" (aka free fluid) died peacefully in 1950th.

Third, intervention for elevated blood pressure is restriction of sodium (aka table salt), lifestyle changes, stress control and meds. Sodium and caffeine free fluids will affect blood pressure for a short time and minimally as long as kidneys are working.

It is all well within "basic health care" course offered in public high school where I live. If your school of nursing still teaches you about "sugar dilution" and nothing about insulin resistance, you better run for your life outta there.