Grading Toxicity (Based on Fasting Glucose)
- Fasting glucose value >ULN – 160 mg/dL
- Fasting glucose value >160 – 250 mg/dL
- Fasting glucose value >250 – 500 mg/dL, hospitalization indicated
- Fasting glucose value >500 mg/dL, life-threatening consequences
Management
Overall Strategy:
- Immunotherapy may be withheld until blood glucose is regulated
- Insulin therapy
- Hydration
- Endocrine consult
Nursing Implementation:
- Discuss that DM1 will likely be permanent
- Review signs and symptoms of hyper/hypoglycemia
- Follow patients closely with checks on blood glucose levels, fruity breath, and other symptoms (e.g., increased infections)
- Assure early intervention
- Provide insulin education (or refer)
- Discuss possibility of other immune-related AEs, including others of endocrine origin
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