Agents to control blood glucose levels

The nurse has delegated the assessment of several hospital clients' blood glucose levels to a practical nurse. The nurse should instruct the practical nurse to assess which client first?

A client who received glargine insulin 30 minutes ago A client who was given 500 mg metformin 1 hour ago A client who was given 250 mg metformin 2 hours ago A client who received 12 units of regular insulin 45 minutes ago Rationale:Regular insulin has a comparatively rapid onset (30 to 60 minutes) and peak (2 to 4 hours), so it is prudent to monitor glucose levels closely. Metformin does not cause hypoglycemia, so reassessment of blood glucose levels would be a lower priority for these clients. Glargine has an onset of 60 to 70 minutes and no peak, so there is minimal risk for hypoglycemia.

The nurse assesses a client after administering insulin and finds that the client is stuporous with a glucose level of 24 mg/dL. What is the nurse's priority action?

Administer glucagon as prescribed. Administer 4 to 6 units of lispro insulin as prescribed. Provide the client with 8 oz of orange juice. Administer 4 to 6 units of glulisine insulin as prescribed. Rationale:Blood glucose levels below 40 mg/dL are indicative of severe hypoglycemia. This client is likely to require glucagon. Giving juice by mouth would be dangerous if the client's level of consciousness is reduced. Insulin of any type would exacerbate the client's condition.

A client receives a dose of insulin lispro at 8 AM. The nurse would assess most carefully for signs and symptoms of possible hypoglycemia at what time?

Between 10 AM and 12 noon Between 2 and 4 PM Between 8:30 and 9:30 AM Between 12 noon and 8 PM Rationale:With insulin lispro, peak effects would occur in 30 to 90 minutes, or between 8:30 and 9:30 AM. Regular insulin peaks in 2 to 4 hours. With insulin detemir, peak effects would occur in 6 to 8 hours, or between 2 and 4 PM. With NPH insulin, peak effects would occur in 4 to 12 hours, or between 12 noon and 8 PM.

The nurse is caring for a client with type 2 diabetes who also has an inflammatory condition requiring corticosteroids. What is the nurse's best action?

Collaborate with the provider to temporarily reduce hypoglycemic medications. Monitor the client's glucose levels more frequently than usual. Assess the client for signs of diabetic ketoacidosis (DKA). Administer supplementary doses of regular insulin as prescribed. Rationale:Corticosteroids tend to increase blood glucose levels, creating a need for careful monitoring. The client may need more, not less, medication. DKA is exclusive to type 1 diabetes. For this client, insulin would only be necessary in cases of extreme hyperglycemia.

A client is receiving acarbose. What would the nurse incorporate into the teaching plan for this client to explain the action of the drug?

Decreases insulin resistance Increases the uptake of glucose Inhibits an enzyme to delay glucose absorption Binds to potassium channels on pancreatic beta cells Rationale:Acarbose inhibits alpha glucosidase, an enzyme, thereby delaying the absorption of glucose. Thiazolidinediones, such as rosiglitazone, decrease insulin resistance. Second-generation sulfonylureas bind to potassium channels on the pancreatic beta cells to improve insulin binding to insulin receptors and increase the number of insulin receptors. Biguanides, such as metformin, increase the uptake of glucose.

The nurse is explaining different types of insulin to a client who has just been diagnosed with type 1 diabetes. What type of insulin should the nurse describe as being available for intravenous administration?

Glargine Detemir NPH Regular Except for regular insulin, all insulins are given via the subcutaneous route.

When preparing to administer a combination of two insulins for a client with type 1 diabetes, what combination is most likely?

Glargine and aspart NPH and regular Detemir and regular Detemir and glulisine A combination of NPH and regular insulin is among the most common combinations that are used in practice. Detemir and glargine cannot be safely mixed with any other insulin.

The nurse discovers the client is hypoglycemic. What drug will the nurse administer intravenously to increase blood sugar level?

Glucagon, 0.5 to 1 mg Nateglinide, 120 mg Chlorpropamide, 100 to 250 mg Diazoxide, 3 to 8 mg/kg Glucagon can be given IV, but diazoxide would be given PO. Both drugs increase blood sugar levels. Nateglinide and chlorpropamide would further lower blood sugar.

When administering insulin, what nursing action would be most appropriate?

Insert the needle at a 45-degree angle for injection. Shake the vial vigorously to ensure thorough mixing before drawing up the dose. Massage the injection site firmly after removing the needle and syringe. Firmly spread the skin of the area of the intended site of injection. Rationale:The needle is inserted at a 45-degree angle for subcutaneous administration. The vial should be gently rotated, and vigorous shaking is to be avoided to ensure uniform suspension of the insulin. Typically, the area is pinched to allow access to the loose connective tissue layer. Gentle pressure should be applied at the injection site.

Which insulin would the nurse need to administer as a separate injection if the order also included NPH insulin?

Lispro Glargine Regular Aspart Insulin glargine cannot be mixed in solution with any other insulin.

Regular insulin may be administered intravenously or intramuscularly in an emergency situation.

Maintenance doses of regular insulin are given by the subcutaneous route only. Regular insulin is given intramuscularly or intravenously in emergency situations.

A client with type 1 diabetes has been inconsistent with blood glucose monitoring, diet, and insulin administration. What manifestations would indicate to the nurse that the client has developed diabetic ketoacidosis (DKA)?

Peripheral edema Arrhythmias Slow, deep respirations Sour breath odor Rationale:Slow, deep respirations are seen with diabetic ketoacidosis as the body attempts to rid itself of high acid levels. The client with diabetic ketoacidosis is typically dehydrated. Arrhythmias do not normally accompany DKA. A fruity breath odor is indicative of diabetic ketoacidosis.

The nurse is administering an antidiabetic agent by subcutaneous injection within 60 minutes before the client's breakfast. Which agent would the nurse most likely to be administering?

Rosiglitazone Repaglinide Miglitol Exenatide Rationale:Exenatide is administered by subcutaneous injection within 60 minutes before morning and evening meals. Rosiglitazone would be administered as a single oral dose. Repaglinide is used orally before meals. Miglitol is given orally with the first bite of each meal.

A client is prescribed sitagliptin. The nurse would expect to administer this drug by which route?

Subcutaneous Oral Intravenous Intramuscular Sitagliptin is administered orally.

The nurse suspects the client with diabetes is hyperglycemic when assessing what signs and symptoms? Select all that apply.

The client's blood pressure is 101/63 mm Hg. The client is weak and moves slowly. The client is reporting a new onset of nausea. The client's heart rate is 106 beats/min with a regular rhythm. The client reports a "pounding headache." Correct Response:The client's blood pressure is 101/63 mm Hg., The client is weak and moves slowly., The client is reporting a new onset of nausea., The client's heart rate is 106 beats/min with a regular rhythm. Rationale:Signs and symptoms of hyperglycemia include tachycardia, hypotension, nausea, weakness, and lethargy. Typically, a headache is more closely associated with hypoglycemia.

A client with type 2 diabetes has not responded well to metformin, so the provider is adding exenatide to the client's regimen. What should the nurse include in the teaching plan?

The relationship between exenatide dose and insulin dose The importance of follow-up laboratory testing The need to keep glucagon accessible in the home Correct technique for subcutaneous injection Rationale:Exenatide is an incretin that is given subcutaneously, twice per day. Hypoglycemia is not treated with glucagon in the home setting. Exenatide would not be given concurrently with insulin. The drug does not require any particular laboratory testing.

The nurse teaches the client who is newly diagnosed with diabetes that the initial reaction to falling blood glucose that serves as a warning to check blood sugar levels will be what?

Thirst Kussmaul respirations Diaphoresis Increased GI activity Rationale:The initial reaction to falling blood glucose level is parasympathetic stimulation—increased GI activity to increase digestion and absorption. Rather rapidly, the SNS responds with a "fight-or-flight" reaction that increases blood glucose levels by initiating the breakdown of fat and glycogen to release glucose for rapid energy. Diaphoresis is a later symptom. Kussmaul respirations and thirst are signs of hyperglycemia.

What drug does the nurse recognize is classified as a biguanide?

Tolbutamide Glipizide Metformin Miglitol Metformin is classified as a biguanide. Miglitol is an alpha-glucosidase inhibitor. Tolbutamide is a first-generation sulfonylurea. Glipizide is a second-generation sulfonylurea.

The nurse explains to the parents of a child newly diagnosed with type 1 diabetes that the difference between type 1 and type 2 diabetes is what?

Type 1 diabetes is sometimes called adult-onset diabetes. Clients with type 1 diabetes have a deficiency of insulin. Type 2 diabetes is treated only with injected insulin. Clients with type 1 diabetes have insulin receptors that are not sensitive to insulin. Rationale:Type 1 diabetes is usually associated with rapid onset, mostly in younger people, and is connected in many cases to viral destruction of the beta cells of the pancreas. Type 1 diabetes always requires insulin replacement because the beta cells are no longer functioning. Type 2 diabetes was once thought to be a disease of mature adults with a slow and progressive onset. Clients with type 2 diabetes are able to produce insulin, but they experience hyperglycemia because their insulin receptors are insensitive to insulin.

Clients with type 2 diabetes have nonfunctioning beta pancreatic cells.

Type 2 diabetes reflects an inability to produce enough insulin as needed or a change in insulin receptor sensitivity.