If she's receiving TPN, the formula and any insulin additives will need to be evaluated and, if necessary, adjusted. Insulin is commonly added to TPN preparations, so the patient may always have the potential for a hypoglycemic reaction. Start by asking your patient if she's been following her diet. Tube-fed patients should have their caloric intake evaluated to make sure the dietary formula and rate of feeding are appropriate. Determine if the reaction developed during or after exercise.
Exercise increases the body's use of glucose, decreasing blood glucose levels.
In general, patients should avoid exercising during peak insulin periods. They should also eat a complex-carbohydrate snack before exercising and talk with their primary health care provider about how to adjust their insulin to meet the rigors of their exercise regimen. Once you've done your detective work, you can help your diabetic patient prevent future hypoglycemic reactions. Check her morning fasting blood glucose level before she receives her insulin or oral hypoglycemic. If you're concerned about your patient's blood glucose level, check it with a finger-stick or blood glucose meter before a reaction occurs.