58-year-old with type 2 diabetes admitted for cellulitis, now presenting with symptomatic hypoglycaemia at 0630.
Bed 12 is Ms. Alvarez, 58-year-old with type 2 diabetes admitted yesterday for cellulitis of her left lower leg. She's on IV cefazolin and sliding scale insulin ordered AC meals and HS. At home she normally takes metformin only. Her bedtime glucose at 2200 last night was 9.8 mmol/L. She received 2 units of rapid-acting insulin per sliding scale at that time. Around 0630 she rang the call bell saying she felt shaky and sweaty. When I went in she appeared pale and slightly confused, saying she 'felt off.' Her capillary glucose at that time was 2.6 mmol/L. She mentioned she didn't eat much dinner last night because she felt nauseated. No vomiting overnight. Vitals now: BP 118/72, HR 104, RR 18, O₂ sat 98% on room air. I gave her 15 grams of oral glucose gel and rechecked in 15 minutes — it improved to 3.8 mmol/L. She's more alert but still fatigued. She's due for her pre-breakfast glucose check and insulin administration at 0730.
Step 1 of 6: Situational Awareness