1000: A 12-year-old female presented to the emergency department with ongoing fatigue and recent weight loss over the past two weeks. The client’s caregiver states she has been experiencing increased thirst and frequent urination, including throughout the night. The client has no significant past medical history. Upon assessment, the client’s mucous membranes are dry. Pulses are regular and palpable. Lung sounds are clear. The abdomen is soft and nontender. The client is alert and oriented x4, but reports a headache, rated 5/10. Immunizations are up to date. Vital signs are T 98.9°F (37.2°C), HR 112, RR 26, BP 92/54, SpO₂ 98% on room air. Fingerstick glucose level is 396 mg/dL (22.0 mmol/L).

1000

• CBC
• BMP
• UA
• HbA1C
• ABG

1000: A 12-year-old female presented to the emergency department with ongoing fatigue and recent weight loss over the past two weeks. The client’s caregiver states she has been experiencing increased thirst and frequent urination, including throughout the night. The client has no significant past medical history. Upon assessment, the client’s mucous membranes are dry. Pulses are regular and palpable. Lung sounds are clear. The abdomen is soft and nontender. The client is alert and oriented x4, but reports a headache, rated 5/10. Immunizations are up to date. Vital signs are T 98.9°F (37.2°C), HR 112, RR 26, BP 92/54, SpO₂ 98% on room air. Fingerstick glucose level is 396 mg/dL (22.0 mmol/L).

1005: Blood and urine specimens collected and sent to the lab. Client tolerated well.

1000: A 12-year-old female presented to the emergency department with ongoing fatigue and recent weight loss over the past two weeks. The client’s caregiver states she has been experiencing increased thirst and frequent urination, including throughout the night. The client has no significant past medical history. Upon assessment, the client’s mucous membranes are dry. Pulses are regular and palpable. Lung sounds are clear. The abdomen is soft and nontender. The client is alert and oriented x4, but reports a headache, rated 5/10. Immunizations are up to date. Vital signs are T 98.9°F (37.2°C), HR 112, RR 26, BP 92/54, SpO₂ 98% on room air. Fingerstick glucose level is 396 mg/dL (22.0 mmol/L).

1005: Blood and urine specimens collected and sent to the lab. Client tolerated well.

1010: Provider is at the bedside speaking with the client and their caregiver. The provider confirmed a diagnosis of Type 1 diabetes mellitus. Plans to admit the client for observation and begin initial management.



1000: A 12-year-old female presented to the emergency department with ongoing fatigue and recent weight loss over the past two weeks. The client’s caregiver states she has been experiencing increased thirst and frequent urination, including throughout the night. The client has no significant past medical history. Upon assessment, the client’s mucous membranes are dry. Pulses are regular and palpable. Lung sounds are clear. The abdomen is soft and nontender. The client is alert and oriented x4, but reports a headache, rated 5/10. Immunizations are up to date. Vital signs are T 98.9°F (37.2°C), HR 112, RR 26, BP 92/54, SpO₂ 98% on room air. Fingerstick glucose level is 396 mg/dL (22.0 mmol/L).

1005: Blood and urine specimens collected and sent to the lab. Client tolerated well.

1010: Provider is at the bedside speaking with the client and their caregiver. The provider confirmed a diagnosis of Type 1 diabetes mellitus. Plans to admit the client for observation and begin initial management.

1030: New orders received to start a consistent carb diet and insulin. Medication education and diet were reviewed with the client and their caregiver.

1030

• Consult: Pediatric Endocrinology, Pediatric Diabetes Educator, Registered Dietitian
• Consistent carbohydrate diet
• Administer insulin glargine (Lantus) 12 units subcutaneously once daily at 8:00 PM
• Check blood glucose ACHS and 0200 for 2 nights
• 
  
• Use insulin lispro (Humalog) subcutaneously before meals and at bedtime per sliding scale:

• If blood glucose < 70 mg/dL:
• Administer 15 g of rapid-acting carbohydrate (e.g., 4 oz juice, 3–4 glucose tablets) or Glucagon 1 mg IM or subcutaneously if ≥ 20 kg
• Recheck glucose in 15 minutes
• If still < 70, repeat treatment