1. A patient has diabetes type 1 and receives insulin for glycemic control. She tells the nurse that she likes to have a glass of wine with dinner. What will the best plan of the nurse for client education include? A. The alcohol could cause pancreatic disease. B. The alcohol could cause serious liver disease. C. The alcohol could predispose you to hypoglycemia. D. The alcohol could predispose you to hyperglycemia. Correct Answer: C. The alcohol could predispose you to hypoglycemia. Alcohol can potentiate hypoglycemic, not hyperglycemic, effects in the client. When the client drinks alcohol, the alcohol can inhibit the liver’s ability to release glucose into the blood. This can be particularly significant for people on stronger medication such as insulin because it can mean that the liver is not able to release enough glycogen to keep the blood glucose levels from going too low under the influence of insulin in the body. Option A: Alcohol can cause pancreatic disease, but the client’s pancreas is not producing any insulin currently. Alcohol abuse is a wellrecognized association of both acute and chronic pancreatitis, with repeated attacks of alcohol-induced acute pancreatic necroinflammation leading to chronic disease. The risk of developing pancreatitis increases with increased consumption of alcohol. Option B: Alcohol can cause liver disease, but the more immediate concern is hypoglycemia. Moderate amounts of alcohol may cause blood sugar to rise, excess alcohol can actually decrease your blood sugar level – which can be dangerous for people with T1D. Option D: People with T1D should only drink while eating food. Beer and sweet wine contain carbohydrates and may raise blood sugar. People may overeat when drinking alcohol which also can increase your BG. 2. A doctor orders insulin lispro (Humalog) 10 units for Alicia, a client with diabetes mellitus. When will the nurse administer this medication? A. When the client is eating B. Thirty minutes before meals C. Fifteen minutes before meals D. When the meal trays arrive on the floor 2 / 3 Correct Answer: A. When the client is eating The onset action for the insulin lispro (Humalog) is 10 to 15 minutes so it must be given when the client is eating to prevent hypoglycemia. Insulin lispro is a new type of insulin. It starts working sooner than other insulin types. It also reaches peak activity faster and goes away sooner. Option B: If taking Regular insulin or longer-acting insulin, the client should generally take it 15 to 30 minutes before a meal. Short-acting, such as Regular (R) insulin, starts working within 30 minutes and lasts about 5 to 8 hours. Option C: Each type of insulin works at a different speed and lasts for a different length of time. Quick-acting, such as insulin lispro (Humalog), begins to work very quickly (5 to 15 minutes) and lasts for 3 to 4 hours. Option D: It must be given when the client is eating, not when the meal trays arrive on the floor. Rapid-acting insulin analogs should be injected within 15 min before a meal or immediately after a meal. The most commonly recommended interval between injection of shortacting (regular) insulin and a meal is 30 min. 3. Nurse Matt makes a home visit to the client with diabetes mellitus. During the visit, Nurse Matt notes the client’s additional insulin vials are not refrigerated. What is the best action by the nurse at this time? A. Instruct the client to label each vial with the date when opened. B. Tell the client there is no need to keep additional vials. C. Have the client place the insulin vials in the refrigerator. D. Have the client discard the vials. Correct Answer: C. Have the client place the insulin vials in the refrigerator. Vials not in use should be refrigerated to preserve drug potency. Vials of insulin not in use should be refrigerated. Extreme temperatures (<36 or >86°F, <2 or >30°C) and excess agitation should be avoided to prevent loss of potency, clumping, frosting, or precipitation. Option A: Writing the date of opening on the vial is good practice, but does not address the need to refrigerate additional vials. Specific storage guidelines provided by the manufacturer should be followed. Insulin in use may be kept at room temperature to limit local irritation at the injection site, which may occur when cold insulin is used. Option B: The client should always have additional vials of insulin available. The patient should always have available a spare bottle of each type of insulin used. Although an expiration date is stamped on each vial of insulin, a loss in potency may occur after the bottle has been in use for >1 month, especially if it was stored at room temperature. Option D: There is no need to discard the vials. If uncertain about the potency of a vial of insulin, the individual should replace the vial in question with another of the same type. The person administering insulin should inspect the bottle before each use for changes (i.e.,