S2

Morning hypoglycemia pattern

Diabetes overlay finding a pattern of pre-breakfast readings of 55–65 mg/dL on three of the past seven days — below the ordered 80–180 range and meeting the hypoglycemia threshold — while daytime readings are in range. The provider was notified at 10:20 with the pattern and timing; an order to reduce the basal insulin was received and taught. Rescue availability was confirmed and the caregiver re-taught glucagon; the pre-breakfast readings will be reassessed next visit to confirm the lows resolve without pushing the daytime pattern out of range.

S3

Regimen no longer controlling glucose

Diabetes overlay finding glucose 250–340 mg/dL on four consecutive days, persistently above the ordered ceiling, without intercurrent illness — a pattern indicating the regimen is no longer holding glucose in range. Ketones were checked per the >240 threshold and were negative. The provider was notified at 13:15 with the pattern; orders to adjust insulin were received and taught, and monitoring frequency increased. The pattern will be reassessed next visit to confirm the adjustment brings glucose toward the ordered range.

S4

Severe hypoglycemia with altered mentation

Diabetes overlay finding a glucose of 41 mg/dL with confusion and diaphoresis — severe hypoglycemia below the 54 mg/dL significant-hypoglycemia threshold. Glucagon was administered per order first because the patient could not safely swallow; glucose rechecked at 96 mg/dL but mentation remained slow, so EMS was activated. The provider was notified at 09:25; once stable, the rescue plan was reinforced and the regimen flagged for review to identify and correct the cause of the low.

S5

Impending ketoacidosis during illness

Diabetes overlay during an intercurrent illness finding glucose 320 mg/dL with positive urine ketones, nausea, and one episode of vomiting — findings meeting the sick-day escalation criteria and concerning for impending ketoacidosis. Insulin had not been stopped, per the sick-day rules. The provider was notified at 11:40 and, given the vomiting and ketones, EMS was arranged; hydration and mental status were monitored pending transport. The sick-day rules were reinforced with the caregiver once the patient was stabilized.

S6

Insulin technique corrected

Diabetes overlay in which observation showed an air bubble in the syringe and under-filling, causing the patient to receive less than the ordered dose — an error that produced unexplained hyperglycemia. The technique was corrected, priming and measurement re-taught, and the patient return-demonstrated correct preparation. The corrected technique restores accurate dosing; the glucose pattern will be reassessed next visit to confirm it returns toward the ordered range.

S7

New diabetic-foot lesion

Diabetes overlay identifying a new 1 cm painless plantar ulcer the patient had not noticed, with absent protective sensation at the site per monofilament — new and high amputation risk in a neuropathic foot. The area was offloaded and the provider notified at 14:15; orders for wound care and podiatry were received. Urgent foot-care teaching was provided and the danger of a painless wound emphasized; the wound and sensation will be reassessed (cross-reference Wounds and Touch/Sensation).

S8

Glucagon readiness gap

Diabetes overlay finding the patient at risk for hypoglycemia but with an expired glucagon kit and a caregiver unsure of its use — a readiness gap in the rescue plan. The provider was notified at 10:05 and an order for a replacement obtained; the caregiver was taught and return-demonstrated correct glucagon administration with a trainer. The restored, in-date rescue and the caregiver’s competence close the gap; rescue readiness will be reconfirmed next visit.

S9

Control improving toward target

Diabetes overlay documenting that self-monitored glucose is now 100–170 mg/dL, within the ordered 80–180 range, with no hypoglycemic events, improved from a prior pattern of frequent readings above 250; the most recent A1c has fallen toward the individualized target. The in-range pattern measured against the ordered range and the improving A1c confirm the plan is working; monitoring, technique, and foot care were reinforced, and the A1c trend was updated in the record.