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Chapter 53: Diabetes Mellitus

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Which assessment data best indicates the client with type 1 diabetes is adhering to the medical treatment regimen?

• The client's fasting blood glucose is 100 mg/dL.
• The client's urine specimen has no ketones.
• The client's glycosylated hemoglobin is 5.8%.
• The client's glucometer reading is 120 mg/dL.

ANSWER:

• A glycosylated hemoglobin (A1C) gives the average of the blood glucose level over the past 3 months and indicates adherence to the

medical treatment regimen. A glycosylated hemoglobin level of 5.8% is close to normal and indicates that the client is adhering to the treatment regimen. The following table shows blood glucose levels and corresponding glycosylated hemoglobin results: Blood Glucose Level Glycosylated.Hemog.Result 70-110 4.0-5.5% Normal

135 6%

170 7%

205 8%

240 9%

275 10%

310 11%

345 12%

RATIONALE WHY THESE AREN'T CORRECT:

• The fasting blood glucose level is obtained after the client is NPO for 8 hours. This blood result does not indicate adherence to the treatment

regimen.

• If the client has no ketones in the urine, it indicates that the body is not breaking down fat for energy, but it does not indicate adherence to the

treatment regimen.

• A glucometer reading of 120 mg/dL indicates a normal blood glucose level, but it is a one-time reading and does not indicate adherence to

the medical treatment regimen.

The client diagnosed with type 1 diabetes is reporting a dry mouth, extreme thirst, and increased urination. Which interventions should the nurse implement? Select ALL that apply.

• Administer one amp of IV 50% glucose.
• Prepare to administer IV regular insulin.
• Inject insulin isophane subcutaneously in the abdomen.
• Hang an IV infusion of D5W at a keep open rate.
• Check the client's blood glucose level via a glucometer.

ANSWER:

• The client's signs and symptoms indicate the client is experiencing diabetic ketoacidosis (DKA), which is treated with IV regular insulin.
• These are signs/symptoms of DKA; therefore, checking the client's blood glucose level is an appropriate intervention.

RATIONALE WHY THESE AREN'T CORRECT:

• One amp of 50% glucose would be used to treat a severe hypoglycemic reaction, and this client does not have signs or symptoms that

indicate hypoglycemia. In fact, the client has signs and symptoms of hyperglycemia.

• Insulin isophane is an intermediate-acting insulin, which is not used to treat hyperglycemia.
• An IV of D5W would cause the client to have further signs and symptoms of DKA; therefore, the nurse should not administer the IV.

The nurse administered 25 units of insulin isophane to a client with type 1 diabetes at 1600. Which intervention should the nurse implement?

• Assess the client for hypoglycemia around 1800.
• Ensure the client eats the nighttime (HS) snack.
• Check the client's serum blood glucose level.
• Serve the client the supper tray.

ANSWER: 2. The nurse needs to ensure the client eats the nighttime (HS) snack to help prevent nighttime hypoglycemia

Rationale why these are not correct:

• Insulin isophane (Humulin N) is an intermediate-acting insulin that peaks 6 to 8 hours after administration; therefore, the client would

experience signs of hypoglycemia around 2200 to 2400.

• A serum blood glucose level would have to be done with a venipuncture and the blood sample must be taken to the laboratory. If the client

needed the blood glucose checked, it should be done with a glucometer at the bedside.

• The supper tray would not help prevent a hypoglycemic reaction because the insulin isophane Humulin N is an intermediate-acting insulin

that peaks in 6 to 8 hours.

The nurse is teaching the client with type 1 diabetes how to use an insulin pen injector. Which information should the nurse discuss with the client?

• Instruct the client to dial in the number of insulin units needed to inject.
• Demonstrate the proper way to draw up the insulin in an insulin syringe.
• Discuss that the insulin pen injector must be used in the abdominal area only.
• Explain that the traditional insulin syringe is less painful than the injector pen.

ANSWER:

• The insulin pen injector resembles a fountain pen. It contains a disposable needle and insulin-filled cartridge. When the client operates the

insulin pen, the correct dose is obtained by turning the dial to the number of insulin units needed.

Rationale why these are not correct:

• The insulin pen injector does not require drawing up insulin in a syringe.
• The insulin pen injector can be used in any subcutaneous site where traditional insulin can be injected.
• Most clients state that there is less injection pain associated with the insulin pen than there is with the traditional insulin syringe.

The nurse is teaching a client with newly diagnosed type 1 diabetes about insulin therapy. Which statements indicate the client needs more teaching concerning insulin therapy? Select ALL that apply.

• "If I have a headache or start getting nervous, I will drink some orange juice."
• "If I pass out at home, a family member should give me a glucagon injection."
• "Because I am taking my insulin daily I do not have to adhere to a diabetic diet."
• "I will check my blood glucose with my glucometer at least once a day."
• "I should administer my insulin in my abdomen for best absorption."

Answer:

• Even with insulin therapy the client should adhere to the American Diabetic Association diet, which recommends "carbohydrate counting." This

statement indicates the client needs more teaching.

Rationale why these are not correct:

• Headache, nervousness, sweating, tremors, and rapid pulse are signs of a hypoglycemic reaction and should be treated with a simple-acting

carbohydrate, such as orange juice, sugar-containing drinks, and hard candy. This statement indicates the client understands the teaching.

• If a client cannot drink or eat a simple carbohydrate for hypoglycemia, then the client should receive a glucagon injection to treat the

hypoglycemic reaction. This indicates the client understands the teaching.

• Monitoring and documenting the blood glucose level is encouraged to determine the effectiveness of the treatment regimen. This indicates

the client understands the client teaching.

• The abdominal area best absorbs insulin; therefore, the client does not need more teaching.