An older client with Type 1 diabetes presents with abdominal cramping, vomiting, lethargy, confusion, and uncertain last insulin or meals. What action should the nurse implement first?

An older client with Type 1 diabetes presents with abdominal cramping, vomiting, lethargy, confusion, and uncertain last insulin or meals. What action should the nurse implement first?

• A. Administer the client's usual dose of insulin
• B. Obtain a serum potassium level
• C. Assess pupillary response to light
• D. Start an intravenous infusion of normal saline

Answer: (D)

The first priority is to restore intravascular volume and perfusion in a suspected diabetic crisis like diabetic ketoacidosis. Starting an IV infusion of normal saline rehydrates the patient, improves tissue perfusion, and helps correct electrolyte disturbances. This step also buys time to assess and stabilize other factors (glucose, electrolytes, acid-base status) before giving insulin. Giving the usual insulin dose before fluids can worsen hypotension and shift potassium into cells, worsening electrolyte balance. After fluids are underway, monitor potassium and other labs and then initiate insulin therapy once the patient’s volume status has improved.

The first priority is to restore intravascular volume and perfusion in a suspected diabetic crisis like diabetic ketoacidosis. Starting an IV infusion of normal saline rehydrates the patient, improves tissue perfusion, and helps correct electrolyte disturbances. This step also buys time to assess and stabilize other factors (glucose, electrolytes, acid-base status) before giving insulin. Giving the usual insulin dose before fluids can worsen hypotension and shift potassium into cells, worsening electrolyte balance. After fluids are underway, monitor potassium and other labs and then initiate insulin therapy once the patient’s volume status has improved.