For a patient with hyperglycemic hyperosmolar syndrome who is being infused with insulin at 0.1 unit/kg/hour with a current glucose of 670 mg/dL, which intervention should the nurse perform during this infusion?

For a patient with hyperglycemic hyperosmolar syndrome who is being infused with insulin at 0.1 unit/kg/hour with a current glucose of 670 mg/dL, which intervention should the nurse perform during this infusion?

• A. Monitor urine output hourly only
• B. Check potassium every 4 hours
• C. Administer subcutaneous insulin every hour
• D. Obtain blood glucose levels every hour

Answer: (D)

During IV insulin therapy for hyperglycemic hyperosmolar syndrome, glucose levels must be watched very closely to guide ongoing titration of the insulin drip and prevent overshoot into hypoglycemia. Checking blood glucose every hour provides real-time data to adjust the infusion rate as the glucose trend changes, and to decide when to add dextrose to the IV fluids as glucose approaches target levels. While monitoring fluids and electrolytes is important—urine output helps assess hydration status and potassium shifts can occur with insulin—hourly glucose checks are the most direct, safety-critical action during the infusion. Subcutaneous insulin isn’t used concurrently with an IV insulin infusion, and potassium levels require attention as well, but the immediate priority is obtaining hourly glucose readings to drive safe insulin titration.

During IV insulin therapy for hyperglycemic hyperosmolar syndrome, glucose levels must be watched very closely to guide ongoing titration of the insulin drip and prevent overshoot into hypoglycemia. Checking blood glucose every hour provides real-time data to adjust the infusion rate as the glucose trend changes, and to decide when to add dextrose to the IV fluids as glucose approaches target levels. While monitoring fluids and electrolytes is important—urine output helps assess hydration status and potassium shifts can occur with insulin—hourly glucose checks are the most direct, safety-critical action during the infusion. Subcutaneous insulin isn’t used concurrently with an IV insulin infusion, and potassium levels require attention as well, but the immediate priority is obtaining hourly glucose readings to drive safe insulin titration.