Chapter 51, Assessment and Management of Patients With Diabetes

Which instruction about insulin administration should a nurse give to a client? 1. "Always follow the same order when drawing the different insulins into the syringe." 2. "Shake the vials before withdrawing the insulin." 3. "Store unopened vials of insulin in the freezer at temperatures well below freezing." 4. "Discard the intermediate-acting insulin if it appears cloudy."

1. "Always follow the same order when drawing the different insulins into the syringe." The nurse should instruct the client to always follow the same order when drawing the different insulins into the syringe. Insulin should never be shaken because the resulting froth prevents withdrawal of an accurate dose and may damage the insulin protein molecules. Insulin should never be frozen because the insulin protein molecules may be damaged. The client doesn't need to discard intermediate-acting insulin if it's cloudy; this finding is normal.

A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, "You look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition? 1. "Your body is using protein and fat for energy instead of glucose." 2. "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism." 3. "You may be having undiagnosed infections, causing you to lose extra weight." 4. "I will refer you to a dietician who can help you with your weight."

1. "Your body is using protein and fat for energy instead of glucose." Persons with type 1 diabetes, particularly those in poor control of the condition, tend to be thin because when the body cannot effectively utilize glucose for energy (no insulin supply), it begins to break down protein and fat as an alternate energy source. Patients may be underweight at the onset of type 1 diabetes because of rapid weight loss from severe hyperglycemia. The goal initially may be to provide a higher-calorie diet to regain lost weight and blood glucose control.

A nurse is assigned to care for a patient who is suspected of having type 2 diabetes. Select all the clinical manifestations that the nurse knows could be consistent with this diagnosis. 1. Fatigue and irritability 2. Blurred or deteriorating vision 3. Sudden weight loss and anorexia 4. Wounds that heal slowly or respond poorly to treatment 5. Polyuria and polydipsia

1. Fatigue and irritability 2. Blurred or deteriorating vision 4. Wounds that heal slowly or respond poorly to treatment 5. Polyuria and polydipsia

The nurse is educating the client with diabetes on setting up a sick plan to manage blood glucose control during times of minor illness such as influenza. Which is the most important teaching item to include? 1. Increase frequency of glucose self-monitoring. 2. Decrease food intake until nausea passes. 3. Do not take insulin if not eating. 4. Take half the usual dose of insulin until symptoms resolve.

1. Increase frequency of glucose self-monitoring. Minor illnesses such as influenza can present a special challenge to a diabetic client. The body's need for insulin increases during illness. Therefore, the client should take the prescribed insulin dose, increase the frequency of glucose monitoring, and maintain adequate fluid intake to counteract the dehydrating effects of hyperglycemia. Clear liquids and juices are encouraged. Taking less than normal dose of insulin may lead to ketoacidosis.

The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine? 1. Increases ability for glucose to get into the cell and lowers blood sugar 2. Creates an overall feeling of well-being and lowers risk of depression 3. Decreases need for pancreas to produce more cells 4. Decreases risk of developing insulin resistance and hyperglycemia

1. Increases ability for glucose to get into the cell and lowers blood sugar Exercise increases trans membrane glucose transporter levels in the skeletal muscles. This allows the glucose to leave the blood and enter into the cells where it can be used as fuel. Exercise can provide an overall feeling of well-being but is not the primary purpose of including in the daily routine of diabetic clients. Exercise does not stimulate the pancreas to produce more cells. Exercise can promote weight loss and decrease risk of insulin resistance but not the primary reason for adding to daily routine.

A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms? 1. Serum glucose level of 52 mg/dl 2. Serum calcium level of 10.2 mg/dl 3. Serum calcium level of 8.9 mg/dl 4. Serum glucose level of 450 mg/dl

1. Serum glucose level of 52 mg/dl Headache, sweating, tremor, pallor, and nervousness typically result from hypoglycemia, an insulin reaction in which serum glucose level drops below 70 mg/dl. Hypoglycemia may occur 4 to 18 hours after administration of isophane insulin suspension or insulin zinc suspension (Lente), which are intermediate-acting insulins. Although hypoglycemia may occur at any time, it usually precedes meals. Hyperglycemia, in which serum glucose level is above 180 mg/dl, causes such early manifestations as fatigue, malaise, drowsiness, polyuria, and polydipsia. A serum calcium level of 8.9 mg/dl or 10.2 mg/dl is within normal range and wouldn't cause the client's symptoms.

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia? 1. Sweating, tremors, and tachycardia 2. Polyuria, polydipsia, and polyphagia 3. Dry skin, bradycardia, and somnolence 4. Bradycardia, thirst, and anxiety

1. Sweating, tremors, and tachycardia Sweating, tremors, and tachycardia, thirst, and anxiety are early signs of hypoglycemia. Dry skin, bradycardia, and somnolence are signs and symptoms associated with hypothyroidism. Polyuria, polydipsia, and polyphagia are signs and symptoms of diabetes mellitus.

A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response? 1. "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." 2. "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." 3. "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." 4. "When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released."

2. "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." Ketones (or ketone bodies) are by-products of fat breakdown in the absence of insulin, and they accumulate in the blood and urine. Ketones in the urine signal an insulin deficiency and that control of type 1 diabetes is deteriorating. When almost no effective insulin is available, the body starts to break down stored fat for energy.

A nurse is preparing a client with type 1 diabetes for discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker? 1. Social worker 2. Dietitian 3. Psychiatrist 4. Home health nurse

2. Dietitian The client should be referred to a dietitian, who will help him gain better control of his blood glucose levels. The client can care for himself, so a home health agency isn't necessary. The client shows no signs of needing a psychiatric referral, and referring the client to a psychiatrist isn't in the nurse's scope of practice. Social workers help clients with financial concerns; the scenario doesn't indicate that the client has a financial concern warranting a social worker at this time.

For a client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume? 1. Cool, clammy skin 2. Increased urine osmolarity 3. Jugular vein distention 4. Decreased serum sodium level

2. Increased urine osmolarity In hyperglycemia, urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glucosuria and polyuria, losing body fluids and experiencing deficient fluid volume. Cool, clammy skin; jugular vein distention; and a decreased serum sodium level are signs of fluid volume excess, the opposite imbalance.

Which category of oral antidiabetic agents exerts the primary action by directly stimulating the pancreas to secrete insulin? 1. Alpha-glucosidase inhibitors 2. Sulfonylureas 3. Thiazolidinediones 4. Biguanides

2. Sulfonylureas A functioning pancreas is necessary for sulfonylureas to be effective. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Biguanides facilitate the action of insulin on peripheral receptor sites. Alpha-glucosidase inhibitors delay the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.

An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: 1. 2 to 5 g of a simple carbohydrate. 2. 25 to 30 g of a simple carbohydrate. 3. 10 to 15 g of a simple carbohydrate. 4. 18 to 20 g of a simple carbohydrate.

3. 10 to 15 g of a simple carbohydrate. To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. Then the client should check his blood glucose after 15 minutes. If necessary, this treatment may be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.

A patient who is 6 months' pregnant was evaluated for gestational diabetes mellitus. The doctor considered prescribing insulin based on the serum glucose result of: 1. 80 mg/dL, 1 hour postprandial. 2. 120 mg/dL, 1 hour postprandial. 3. 138 mg/dL, 2 hours postprandial. 4. 90 mg/dL before meals.

3. 138 mg/dL, 2 hours postprandial. The goals for a 2-hour, postprandial blood glucose level are less than 120 mg/dL in a patient who might develop gestational diabetes.

A nurse is caring for a client with type 1 diabetes who exhibits confusion, light-headedness, and aberrant behavior. The client is conscious. The nurse should first administer: 1. 10 units of fast-acting insulin. 2. I.M. or subcutaneous glucagon. 3. 15 to 20 g of a fast-acting carbohydrate such as orange juice. 4. I.V. bolus of dextrose 50%.

3. 15 to 20 g of a fast-acting carbohydrate such as orange juice. This client is experiencing hypoglycemia. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost consciousness, the nurse should administer I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The nurse shouldn't administer insulin to a client who's hypoglycemic; this action will further compromise the client's condition.

A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well-controlled? 1. 7.5 % 2. 8.5% 3. 6.5% 4. 8.0%

3. 6.5% Normally the level of glycosylated hemoglobin is less than 7%. Thus a level of 6.5% would indicate that the client's blood glucose level is well-controlled. According to the American Diabetes Association, a glycosylated hemoglobin of 7% is equivalent to an average blood glucose level of 150 mg/dL. Thus, a level of 7.5% would indicate less control. Amount of 8% or greater indicate that control of the client's blood glucose level has been inadequate during the previous 2 to 3 months.

A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R taken at 6:30 AM will reach peak effectiveness by: 1. 2:30 PM. 2. 12:30 PM. 3. 8:30 AM. 4. 10:30 AM.

3. 8:30 AM. Short-acting insulin reaches its peak effectiveness 2 to 3 hours after administration. See Table 30-3 in the text.

Which statement is true regarding gestational diabetes? 1. It occurs in most pregnancies. 2. There is a low risk for perinatal complications. 3. A glucose challenge test should be performed between 24 and 28 weeks. 4. Onset usually occurs in the first trimester.

3. A glucose challenge test should be performed between 24 and 28 weeks. A glucose challenge test should be performed between 24 and 48 weeks in women at average risk. It occurs in 2% to 5% of all pregnancies. Onset usually occurs in the second or third trimester. There is an above-normal risk for perinatal complications.

A nurse educates a group of clients with diabetes mellitus on the prevention of diabetic nephropathy. Which of the following suggestions would be most important? 1. Take the antidiabetic drugs regularly. 2. Drink plenty of fluids. 3. Control blood glucose levels. 4. Eat a high-fiber diet.

3. Control blood glucose levels. Controlling blood glucose levels and any hypertension can prevent or delay the development of diabetic nephropathy. Drinking plenty of fluids does not prevent diabetic nephropathy. Taking antidiabetic drugs regularly may help to control blood glucose levels, but it is the control of these levels that is most important. A high-fiber diet is unrelated to the development of diabetic nephropathy.

A client with diabetes is receiving an oral antidiabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer? 1. Repaglinide 2. Glipizide 3. Metformin 4. Glyburide

3. Metformin Metformin is a biguanide and along with the thiazolidinediones (rosiglitazone and pioglitazone) are categorized as insulin sensitizers; they help tissues use available insulin more efficiently. Glyburide and glipizide which are sulfonylureas, and repaglinide, a meglitinide, are described as being insulin releasers because they stimulate the pancreas to secrete more insulin.

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level? 1. Arm and leg trembling 2. Cool, moist skin 3. Rapid, thready pulse 4. Slow, shallow respirations

3. Rapid, thready pulse This client's abnormally high blood glucose level indicates hyperglycemia, which typically causes polyuria, polyphagia, and polydipsia. Because polyuria leads to fluid loss, the nurse should expect to assess signs of deficient fluid volume, such as a rapid, thready pulse; decreased blood pressure; and rapid respirations. Cool, moist skin and arm and leg trembling are associated with hypoglycemia. Rapid respirations — not slow, shallow ones — are associated with hyperglycemia.

A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check: 1. urine glucose level. 2. serum fructosamine level. 3. glycosylated hemoglobin level. 4. fasting blood glucose level.

3. glycosylated hemoglobin level. Because some of the glucose in the bloodstream attaches to some of the hemoglobin and stays attached during the 120-day life span of red blood cells, glycosylated hemoglobin levels provide information about blood glucose levels during the previous 3 months. Fasting blood glucose and urine glucose levels give information only about glucose levels at the point in time when they were obtained. Serum fructosamine levels provide information about blood glucose control over the past 2 to 3 weeks.

A controlled type 2 diabetic client states, "The doctor said if my blood sugars remain stable, I may not need to take any medication." Which response by the nurse is most appropriate? 1. "Some doctors do not treat blood sugar elevation until symptoms appear." 2. "You misunderstood the doctor. Let's ask for clarification." 3 3. "You will be placed on a strict low-sugar diet for better control." 4. "Diet, exercise, and weight loss can eliminate the need for medication."

4. "Diet, exercise, and weight loss can eliminate the need for medication." Dieting, exercise, and weight loss can control and/or delay the need for medication to treat type 2 diabetes mellitus in some clients. Because the client is controlling blood sugars, changing the diet is not indicated. Controlling blood glucose levels will prevent multisystem complications and should be the mainstay of treatment for diabetes mellitus. Although clarification is appropriate, stating the client misunderstood can close the line of communication between client and nurse.

A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating: 1. "The test must be repeated following a 12-hour fast." 2. "Your insulin regimen must be altered significantly." 3. "It looks like you aren't following the ordered diabetic diet." 4. "It tells us about your sugar control for the last 3 months."

4. "It tells us about your sugar control for the last 3 months." The nurse is providing accurate information to the client when she states that the glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn't require a fasting period before blood is drawn. The nurse can't conclude that the result occurs from poor dietary management or inadequate insulin coverage.

A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? 1. "Inject insulin into healthy tissue with large blood vessels and nerves." 2. "Administer insulin into sites above muscles that you plan to exercise heavily later that day." 3. "Administer insulin into areas of scar tissue or hypertrophy whenever possible." 4. "Rotate injection sites within the same anatomic region, not among different regions."

4. "Rotate injection sites within the same anatomic region, not among different regions." The nurse should instruct the client to rotate injection sites within the same anatomic region. Rotating sites among different regions may cause excessive day-to-day variations in the blood glucose level; also, insulin absorption differs from one region to the next. Insulin should be injected only into healthy tissue lacking large blood vessels, nerves, or scar tissue or other deviations. Injecting insulin into areas of hypertrophy may delay absorption. The client shouldn't inject insulin into areas of lipodystrophy (such as hypertrophy or atrophy); to prevent lipodystrophy, the client should rotate injection sites systematically. Exercise speeds drug absorption, so the client shouldn't inject insulin into sites above muscles that will be exercised heavily.

When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? 1. Area for insulin injection 2. Technique for injecting 3. Duration of the insulin 4. Accuracy of the dosage

4. Accuracy of the dosage The measurement of insulin is most important and must be accurate because clients may be sensitive to minute dose changes. The duration, area, and technique for injecting should also to be noted.

A client has been diagnosed with prediabetes and discusses treatment strategies with the nurse. What can be the consequences of untreated prediabetes? 1. CVA 2. cardiac disease 3. type 2 diabetes 4. All options are correct.

4. All options are correct. The NIDDK has developed criteria that identify people with prediabetes, which can lead to type 2 diabetes, heart disease, and stroke.

A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites? 1. Insulin is absorbed more slowly at abdominal injection sites than at other sites. 2. Insulin is absorbed rapidly regardless of the injection site. 3. Insulin is absorbed unpredictably at all injection sites. 4. Insulin is absorbed more rapidly at abdominal injection sites than at other sites.

4. Insulin is absorbed more rapidly at abdominal injection sites than at other sites. Subcutaneous insulin is absorbed most rapidly at abdominal injection sites, more slowly at sites on the arms, and slowest at sites on the anterior thigh. Absorption after injection in the buttocks is less predictable.

NPH is an example of which type of insulin? 1. Long-acting 2. Rapid-acting 3. Short-acting 4. Intermediate-acting

4. Intermediate-acting

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? 1. It decreases the intestinal absorption of glucose. 2. It aids in the process of gluconeogenesis. 3. It stimulates the pancreatic beta cells. 4. It carries glucose into body cells.

4. It carries glucose into body cells. Insulin carries glucose into body cells as their preferred source of energy. Besides, it promotes the liver's storage of glucose as glycogen and inhibits the breakdown of glycogen back into glucose. Insulin does not aid in gluconeogenesis but inhibits the breakdown of glycogen back into glucose. Insulin does not have an effect on the intestinal absorption of glucose.

A patient who is diagnosed with type 1 diabetes would be expected to: 1. Have no damage to the islet cells of the pancreas. 2. Receive daily doses of a hypoglycemic agent. 3. Be restricted to an American Diabetic Association diet. 4. Need exogenous insulin.

4. Need exogenous insulin. Type 1 diabetes is characterized by the destruction of pancreatic beta cells that require exogenous insulin.

A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia? 1. Polyuria, headache, and fatigue 2. Polyphagia and flushed, dry skin 3. Polydipsia, pallor, and irritability 4. Nervousness, diaphoresis, and confusion

4. Nervousness, diaphoresis, and confusion Signs and symptoms associated with hypoglycemia include nervousness, diaphoresis, weakness, light-headedness, confusion, paresthesia, irritability, headache, hunger, tachycardia, and changes in speech, hearing, or vision. If untreated, signs and symptoms may progress to unconsciousness, seizures, coma, and death. Polydipsia, polyuria, and polyphagia are symptoms associated with hyperglycemia.

A nurse is teaching a diabetic support group about the causes of type 1 diabetes. The teaching is determined to be effective when the group is able to attribute which factor as a cause of type 1 diabetes? 1. Obesity 2. Altered glucose metabolism 3. Rare ketosis 4. Presence of autoantibodies against islet cells

4. Presence of autoantibodies against islet cells There is evidence of an autoimmune response in type 1 diabetes. This is an abnormal response in which antibodies are directed against normal tissues of the body, responding to these tissues as if they were foreign. Autoantibodies against islet cells and against endogenous (internal) insulin have been detected in people at the time of diagnosis and even several years before the development of clinical signs of type 1 diabetes.

The diabetic client asks the nurse why shoes and socks are removed at each office visit. Which assessment finding is most significant in determining the protocol for inspection of feet? 1. Nephropathy 2. Autonomic neuropathy 3. Retinopathy 4. Sensory neuropathy

4. Sensory neuropathy Neuropathy results from poor glucose control and decreased circulation to nerve tissues. Neuropathy involving sensory nerves located in the periphery can lead to lack of sensitivity, which increases the potential for soft tissue injury without client awareness. The feet are inspected on each visit to insure no injury or pressure has occurred. Autonomic neuropathy, retinopathy, and nephropathy affect nerves to organs other than feet.

Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? 1. The client has been exercising more than usual. 2. The client has not consumed sufficient calories. 3. The client continues medication therapy despite adequate food intake. 4. The client has eaten and has not taken or received insulin.

4. The client has eaten and has not taken or received insulin. If the client has eaten and has not taken or received insulin, DKA is more likely to develop. Hypoglycemia is more likely to develop if the client has not consumed food and continues to take insulin or oral antidiabetic medications, if the client has not consumed sufficient calories, or if client has been exercising more than usual.

The greatest percentage of people have which type of diabetes? 1. Impaired glucose tolerance 2. Gestational 3. Type 1 4. Type 2

4. Type 2 Type 2 diabetes accounts for 90% to 95% of all diabetes. Type 1 accounts for 5% to 10% of all diabetes. Gestational diabetes has an onset during pregnancy. Impaired glucose tolerance is defined as an oral glucose tolerance test value between 140 mg/dL and 200 mg/dL.

Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer? 1. Applying a heating pad 2. Debriding the wound three times per day 3. Cleaning the wound with a povidone-iodine solution 4. Using sterile technique during the dressing change

4. Using sterile technique during the dressing change The nurse should perform the dressing changes using sterile technique to prevent infection. Applying heat should be avoided in a client with diabetes mellitus because of the risk of injury. Cleaning the wound with povidone-iodine solution and debriding the wound with each dressing change prevents the development of granulation tissue, which is essential in the wound healing process.

Which factor is the focus of nutrition intervention for clients with type 2 diabetes? 1. Carbohydrate intake 2. Blood glucose level 3. Protein metabolism 4. Weight loss

4. Weight loss Weight loss is the focus of nutrition intervention for clients with type 2 diabetes. A low-calorie diet may improve clinical symptoms, and even a mild to moderate weight loss, such as 10 to 20 pounds, may lower blood glucose levels and improve insulin action. Consistency in the total amount of carbohydrates consumed is considered an important factor that influences blood glucose level. Protein metabolism is not the focus of nutrition intervention for clients with type 2 diabetes.

The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan? 1. There is no need to inject air into the bottle of insulin before withdrawing the insulin. 2. When mixing insulin, the NPH insulin is drawn up into the syringe first. 3. If two different types of insulin are ordered, they need to be given in separate injections. 4. When mixing insulin, the regular insulin is drawn up into the syringe first.

4. When mixing insulin, the regular insulin is drawn up into the syringe first. When rapid-acting or short-acting insulins are to be given simultaneously with longer-acting insulins, they are usually mixed together in the same syringe; the longer-acting insulins must be mixed thoroughly before being drawn into the syringe. The American Diabetic Association recommends that the regular insulin be drawn up first. The most important issues are that patients (1) are consistent in technique, so the wrong dose is not drawn in error or the wrong type of insulin, and (2) do not inject one type of insulin into the bottle containing a different type of insulin. Injecting cloudy insulin into a vial of clear insulin contaminates the entire vial of clear insulin and alters its action.

Retinopathy

a complication of diabetes in which the small blood vessels that nourish the retina in the eye are damaged

Insulin pump

a continuous subcutaneous insulin infusion device that delivers insulin on a 24-hour basis

Diabetes

a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both

Ketone

a highly acidic substance formed when the liver breaks down free fatty acids in the absence of insulin

Insulin

a hormone secreted by the beta cells of the islets of Langerhans of the pancreas that is necessary for the metabolism of carbohydrates, proteins, and fats; a deficiency of insulin results in diabetes

Nephropathy

a long-term complication of diabetes in which the kidney cells are damaged; characterized by microalbuminuria in early stages and progressing to end-stage kidney disease

Neuropathy

a long-term complication of diabetes resulting from damage to the nerve cell

glycated hemoglobin (glycosylated hemoglobin, HgbA1C, or A1C):

a measure of glucose control that is a result of glucose molecule attaching to hemoglobin for the life of the red blood cell (120 days)

diabetic ketoacidosis (DKA)

a metabolic derangement in type 1 diabetes that results from a deficiency of insulin; highly acidic ketone bodies are formed, resulting in acidosis

Type 1 diabetes

a metabolic disorder characterized by an absence of insulin production and secretion from autoimmune destruction of the beta cells of the islets of Langerhans in the pancreas; formerly called insulin-dependent diabetes, or juvenile diabetes

Type 2 Diabetes

a metabolic disorder characterized by the relative deficiency of insulin production and a decreased insulin action and increased insulin resistance; formerly called non-insulin-dependent diabetes, or adult-onset diabetes

hyperglycemic hyperosmolar syndrome (HHS):

a metabolic disorder of type 2 diabetes resulting from a relative insulin deficiency initiated by an illness that raises the demand for insulin

impaired fasting glucose (IFG) or impaired glucose tolerance (IGT)

a metabolic stage intermediate between normal glucose homeostasis and diabetes; referred to as prediabetes

self-monitoring of blood glucose (SMBG)

a method of capillary blood glucose testing

latent autoimmune diabetes of adults (LADA)

a subtype of diabetes

Gestational diabetes

any degree of glucose intolerance with its onset during pregnancy

fasting plasma glucose (FPG)

blood glucose determination obtained in the laboratory after fasting for at least 8 hours

Hyperglycemia

elevated blood glucose level

Prediabetes

impaired glucose metabolism in which blood glucose concentrations fall between normal levels and those considered diagnostic for diabetes; includes impaired fasting glucose and impaired glucose tolerance, not clinical entities in their own right but risk factors for future diabetes and cardiovascular disease

Hypoglycemia

low blood glucose level

medical nutrition therapy (MNT)

nutritional therapy prescribed for management of diabetes that usually is given by a registered dietician

Glycemic index

the amount a given food increases the blood glucose level compared with an equivalent amount of glucose