Reference — Endocrine
Diabetes Patient Education Reference
Sick-day rules, foot care, glucose monitoring technique, diet basics, insulin storage, and when to seek emergency care — structured teaching reference for diabetes patient education.
Educational use only. Individualize all diabetes education to the patient's specific medications, targets, and provider guidance. Refer to certified diabetes care and education specialist (CDCES) when available. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Sick-Day Rules
| Rule | Details & Rationale |
|---|---|
| NEVER stop insulin | Even if not eating — illness increases counter-regulatory hormones and glucose even without food. Continue basal insulin; adjust bolus doses based on glucose and carbohydrate intake. |
| Check glucose frequently | Every 2–4 hours when sick; more often if glucose is changing rapidly. |
| Check ketones (Type 1 DM) | Urine or blood ketones if glucose > 240 mg/dL and ill; positive ketones with high glucose = call provider; large ketones + vomiting = go to ER. |
| Stay hydrated | Sip water or clear fluids (broth, electrolyte drinks) — 8 oz per hour to prevent dehydration and ketone buildup. Drink calorie-containing fluids if unable to eat solid food. |
| Eat what you can tolerate | Bland, easily digestible foods (crackers, toast, soup, applesauce, bananas). If unable to eat, carbohydrate-containing fluids (regular soda in small amounts, juice) to prevent severe hypoglycemia. |
| Know when to call provider | Glucose > 240 mg/dL for more than 1–2 checks; inability to keep fluids down; symptoms of DKA (fruity breath, nausea, abdominal pain, rapid breathing, excessive thirst/urination). |
| Know when to go to ER | Loss of consciousness, seizure, large ketones + vomiting (dehydrated), glucose > 400 mg/dL unresponsive to treatment, confusion. |
Foot Care
| Practice | Guidance |
|---|---|
| Daily foot inspection | Check top, bottom, between toes, heels — use a mirror or have someone check if unable to see bottom of feet. Look for: cuts, blisters, cracks, redness, swelling, warmth, color changes. |
| Wash and dry carefully | Lukewarm water (test temperature with elbow — neuropathy reduces temperature sensation). Dry thoroughly between toes — moisture promotes fungal growth and skin breakdown. |
| Moisturize (not between toes) | Apply lotion to dry skin on heels and dorsum — do NOT apply between toes (increases moisture, fungal risk). |
| Inspect shoes before wearing | Shake out and check inside of shoe with hand before putting on — pebbles, seams, or foreign objects cause pressure injuries that patient cannot feel. |
| Wear proper footwear | Well-fitting shoes with adequate toe box; socks without tight elastics; no bare feet — even at home (injury risk without pain sensation as warning). |
| Nail care | Cut nails straight across (not curved); avoid cutting corners (ingrown nail risk). Refer to podiatrist for thick, fungal, or ingrown nails — do NOT have patient cut their own problematic nails. |
| No heating pads or hot water bottles | Peripheral neuropathy impairs heat sensation — burns can occur without patient noticing. |
| Annual monofilament test | Provider tests protective sensation with 10g Semmes-Weinstein monofilament — inability to detect monofilament = high neuropathy risk, higher surveillance and foot care frequency. |
Glucose Monitoring
| Topic | Key Points |
|---|---|
| Lancet technique | Use side of fingertip (more capillary blood, less nerve endings) — not the tip center. Rotate sites to avoid callus formation. Keep lancet device set to appropriate depth. |
| Adequate sample size | Ensure sufficient blood drop — insufficient sample causes error codes or inaccurate readings. Do not squeeze finger excessively (dilutes capillary blood with interstitial fluid). |
| Calibration and QC | Check meter expiration, strip expiration; run QC solution regularly per meter instructions; store strips at room temperature, away from heat/humidity/light. |
| Target ranges (general) | Fasting/preprandial: 80–130 mg/dL; 2 hours postprandial: < 180 mg/dL; A1C target: < 7% for most non-pregnant adults. Provider may individualize these targets. |
| CGM (continuous glucose monitor) | Sensor placed under skin; provides real-time glucose and trend arrows every 5 minutes; trends more actionable than single values; calibration varies by device; lag time compared to blood glucose. |
| Record keeping | Log time, glucose value, insulin doses, carbohydrates eaten, activity, illness — patterns guide insulin adjustment. Many apps automate this; paper logs also acceptable. |
Diet & Nutrition Basics
| Concept | Teaching Points |
|---|---|
| Carbohydrate counting | Carbohydrates (not just sugar) raise blood glucose — bread, rice, pasta, fruit, milk, starchy vegetables all count. Typical meals: 45–60g carbs; snacks: 15–30g. Use nutrition labels: "total carbohydrates" — subtract fiber for net carbs. |
| Plate method | Simple visual: ½ plate non-starchy vegetables; ¼ plate lean protein; ¼ plate whole grains or starchy vegetables. Add small fruit and low-fat dairy on the side. |
| Glycemic index | Lower GI foods (whole grains, legumes, most vegetables) raise glucose more slowly than high GI foods (white bread, white rice, sugary drinks). Fiber, protein, and fat slow glucose absorption. |
| Consistent meal timing | Eat at consistent times to match insulin timing. Skipping meals causes hypoglycemia if insulin was taken. Alcohol lowers glucose — never drink on an empty stomach. |
| Foods to limit | Sugary beverages (juice, regular soda, sweet tea), concentrated sweets, white bread/rice/pasta, processed snack foods, high-sodium foods (increases cardiovascular risk in DM). No single food is "forbidden" — portion and frequency matter. |
Insulin Storage & Safety
| Topic | Guidance |
|---|---|
| Unopened vials/pens | Refrigerate (36–46°F / 2–8°C); do NOT freeze — frozen insulin is damaged and must be discarded; use by expiration date |
| In-use vials/pens | Room temperature (below 77–80°F) for up to 28–30 days (varies by insulin type — check package insert); discard after manufacturer's in-use expiration |
| Inspect before use | Clear insulins (glargine, aspart, lispro): should be clear and colorless — discard if cloudy or has particles. NPH: uniformly cloudy white after gentle rolling — discard if clumped or frosted. |
| Avoid temperature extremes | Never leave in car in summer (heat degrades insulin rapidly); never freeze; keep away from direct sunlight; use insulated case for travel |
| Sharps disposal | Use FDA-cleared sharps container; never recap needles; community disposal programs vary by state — educate patient on local rules; never dispose in regular trash without a container |
When to Seek Care
| Situation | Action |
|---|---|
| Glucose consistently above target despite following regimen | Call provider — medication adjustment may be needed |
| Hypoglycemia not responding to Rule of 15 after 2 attempts | Call provider or go to ER |
| Nausea/vomiting — unable to keep fluids down for > 4 hours | Call provider or go to ER — risk of DKA with dehydration |
| Glucose > 240 mg/dL with ketones (Type 1) or > 300–400 mg/dL | Call provider; go to ER if symptoms of DKA present |
| Signs of infection in foot or wound (redness, swelling, warmth, purulent drainage) | Call provider within 24 hours — diabetic foot infections can progress to osteomyelitis rapidly |
| New or worsening chest pain, shortness of breath, neurological symptoms | Call 911 — diabetics have higher cardiovascular event risk; silent MI can occur without classic chest pain |
Related Resources
Diabetes Mellitus FundamentalsType 1 vs Type 2, diagnostics, complications, and nursing considerations
Open →Hypoglycemia Management GuideRule of 15, severe hypoglycemia, glucagon, and Somogyi vs dawn phenomenon
Open →Diabetic Foot Ulcers GuideWagner classification, DFU assessment, prevention, and wound care
Open →Standards & sources
Fact-checked Jun 20, 2026This page is written to align with American Diabetes Association (ADA) Standards of Care · American Association of Clinical Endocrinology (AACE). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →