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Imbalanced Nutrition Less Than Body Requirements — Diabetes Mellitus

 Imbalanced Nutrition Less Than Body Requirements — Diabetes Mellitus Nursing Care Plans

Nursing Diagnosis: Imbalanced Nutrition Less Than Body Requirements
May be related to:
  • Insulin deficiency (decreased uptake and utilization of glucose by the tissues, resulting in increased protein/fat metabolism)
  • Decreased oral intake: anorexia, nausea, gastric fullness, abdominal pain; altered consciousness
  • Hypermetabolic state: release of stress hormones (e.g., epinephrine, cortisol, and growth hormone), infectious process
Possibly evidenced by:
  • Increased urinary output, dilute urine
  • Reported inadequate food intake, lack of interest in food
  • Recent weight loss; weakness, fatigue, poor muscle tone
  • Diarrhea
  • Increased ketones (end product of fat metabolism)
Desired Outcomes: 
  • Ingest appropriate amounts of calories/nutrients.
  • Display usual energy level.
  • Demonstrate stabilized weight or gain toward usual/desired range with normal laboratory values.
Nursing Interventions Rationale
Weigh daily or as indicated. Assesses adequacy of nutritional intake (absorption and utilization).
Ascertain patient’s dietary program and usual pattern; compare with recent intake. Identifies deficits and deviations from therapeutic needs.
Auscultate bowel sounds. Note reports of abdominal pain/bloating, nausea, vomiting of undigested food. Maintain nothing by mouth (NPO) status as indicated. Hyperglycemia and fluid and electrolyte disturbances can decrease gastric motility/function (distension or ileus), affecting choice of interventions. Note: Long-term difficulties with decreased gastric emptying and poor intestinal motility suggest autonomic neuropathies affecting the GI tract and requiring symptomatic treatment.
Provide liquids containing nutrients and electrolytes as soon as patient can tolerate oral fluids; progress to more solid food as tolerated. Oral route is preferred when patient is alert and bowel function is restored.
Identify food preferences, including ethnic/cultural needs. If patient’s food preferences can be incorporated into the meal plan, cooperation with dietary requirements may be facilitated after discharge.
Include SO in meal planning as indicated. Promotes sense of involvement; provides information for SO to understand nutritional needs of patient. Note:Various methods available or dietary planning include exchange list, point system, glycemic index, or preselected menus.
Observe for signs of hypoglycemia, e.g., changes in level of consciousness, cool/clammy skin, rapid pulse, hunger, irritability, anxiety, headache, lightheadedness, shakiness. Once carbohydrate metabolism resumes (blood glucose level reduced) and as insulin is being given, hypoglycemia can occur. If patient is comatose, hypoglycemia may occur without notable change in level of consciousness (LOC). This potentially life-threatening emergency should be assessed and treated quickly per protocol. Note: Type 1 diabetics of long standing may not display usual signs of hypoglycemia because normal response to low blood sugar may be diminished.
Perform fingerstick glucose testing. Bedside analysis of serum glucose is more accurate (displays current levels) than monitoring urine sugar, which is not sensitive enough to detect fluctuations in serum levels and can be affected by patient’s individual renal threshold or the presence of urinary retention/renal failure. Note: Some studies have found that a urine glucose of 20% may be correlated to a blood glucose of 140–360 mg/dL.
Administer regular insulin by intermittent or continuous IV method, e.g., IV bolus followed by a continuous drip via pump of approximately 5–10 U/hr so that glucose is reduced by 50 mg/dL/hr. Regular insulin has a rapid onset and thus quickly helps move glucose into cells. The IV route is the initial route of choice because absorption from subcutaneous tissues may be erratic. Many believe the continuous method is the optimal way to facilitate transition to carbohydrate metabolism and reduce incidence of hypoglycemia.
Administer glucose solutions, e.g., dextrose and half-normal saline. Glucose solutions may be added after insulin and fluids have brought the blood glucose to approximately 400 mg/dL. As carbohydrate metabolism approaches normal, care must be taken to avoid hypoglycemia.
Provide diet of approximately 60% carbohydrates, 20% proteins, 20% fats in designated number of meals/snacks. Complex carbohydrates (e.g., corn, peas, carrots, broccoli, dried beans, oats, apples) decrease glucose levels/insulin needs, reduce serum cholesterol levels, and promote satiation. Food intake is scheduled according to specific insulin characteristics (e.g., peak effect) and individual patient response. Note:A snack at bedtime (hs) of complex carbohydrates is especially important (if insulin is given in divided doses) to prevent hypoglycemia during sleep and potential Somogyi response. <
Administer other medications as indicated, e.g., metoclopramide (Reglan); tetracycline. May be useful in treating symptoms related to autonomic neuropathies affecting GI tract, thus enhancing oral intake and absorption of nutrients.