Altered Mental Status in a Patient With Insulin-Dependent Diabetes

Case Study

A rapid response event was initiated for a patient with a blood glucose reading by finger stick of <10 mg/dL. On arrival of the rapid response team, the patient was somnolent but arousable to tactile stimuli. Nursing staff reported that the patient was a 75-year-old male with a history of end-stage renal disease on hemodialysis, type 2 diabetes mellitus, and congestive heart failure, who was admitted to the hospital for management of volume overload in the setting of missed dialysis. The patient had a malfunctioning atrioventricular (AV) fistula and was scheduled for fistula repair. He had been made nil per os (NPO) the night prior. It was noted that he received two-thirds of his usual dose of long-acting subcutaneous insulin and three units of short-acting insulin with a bedtime snack last evening. The patient’s nurse noted that the patient has mentioned that his diabetes was difficult to control, and he often experienced wide fluctuations in his blood glucose.