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In type 1 diabetes there is an absolute lack of insulin due to complete failure of the pancreas. In type 2 diabetes some insulin is produced but may not be properly used.

Random blood glucose 195 mg/dL (10.82 mmol/L) Laboratory values that are considered normal are hemoglobin A1C less than 6.5 percent, fasting plasma glucose of (FPG) less than 100 mg/dL or less than 140 mg/dL 2 hours after an oral glucose tolerance test (GTT). Urine should be free of ketones. A hemoglobin A1C value that is greater than or equal to 6.5 percent, a fasting blood glucose greater than 126mg/dL, or a blood glucose level greater than 200 mg/dL 2 hours after a glucose tolerance test (GTT) indicate diabetes mellitus. Values between these levels are considered to place clients at increased risk for diabetes mellitus and require further evaluation. A random blood glucose level is expected to correlate with the two-hour GTT results and should be below 200 mg/dL.

Which criterion about insulin would prompt a diagnosis of type 1 diabetes?

Complete failure of insulin secretion In type 1 diabetes there is an absolute lack of insulin due to complete failure of the pancreas. In type 2 diabetes some insulin is produced but may not be properly used.

A client with type 1 diabetes mellitus wishes to stop taking insulin injections. What option is appropriate?

Using an insulin infusion pump Clients with type 1 diabetes mellitus require exogenous insulin because they have absolute lack of their own secretion. Insulin is a protein that would be digested if taken orally. To avoid injections, clients could use an insulin pump, which provides continuous infusion through a catheter placed under the skin that is changed every few days. While some herbal preparations may help lower blood glucose, they do not replace insulin. While aerobic activity helps mobilize glucose, it does not replace insulin. Metformin is an insulin sensitizer that enhances insulin utilization, but does not replace insulin.

A client diagnosed with type 2 diabetes has been instructed about managing his condition with diet. The nurse determines further teaching is necessary when the client states:

"I must avoid all candies and cookies, but can eat unlimited amounts of pasta and breads." The client needs more education regarding carbohydrate sources. All the other statements are correctly stated and demonstrate good understanding of dietary needs for the type 2 diabetic.

The nurse is reviewing assessment data and determines which client is at highest risk for developing type 2 diabetes?

A 45-year-old obese female with a sedentary lifestyle The person most at risk for developing type 2 diabetes is the 45-year-old obese female with a sedentary lifestyle. Other risk factors include family history, over age 40, and history of gestational diabetes. The 60-year-old would have developed it before age 60, if there were additional risk factors. Diabetes and metabolic syndrome are due to pancreatic problems, not liver problems.

Which clients with diabetes mellitus would the nurse anticipate to have persistent elevation of blood glucose levels? Select all that apply.

A client with high anxiety A client with COPD taking steroids A client with a newly diagnosed leg fracture High anxiety would increase secretion of catecholamines such as epinephrine. A fracture is a stressor that raises growth hormone levels. Steroids are glucocorticoids used to treat inflammatory conditions such as COPD and autoimmune disorders. Growth hormone, glucocorticoids, and epinephrine raise blood glucose levels.

The critical care nurse has just admitted a client with diabetic ketoacidosis (DKA) whose blood glucose level is 877 mg/dL (48.67 mmol/L). The client's breath has a fruity odor and the client is confused. Which of these does the nurse set as the priority at this time?

Administration of intravenous fluids Goals of care for clients with DKA include administration of insulin and intravenous fluid and electrolyte replacement solutions. A common reason for development of DKA is an infection; monitoring for a fever should not take priority over administration of insulin and fluid replacement.

The pancreas is an endocrine organ that is composed of the acini and the islets of Langerhans. The islets of Langerhans have alpha, beta, and delta cells as well as the PP cell. Which cells secrete insulin?

Beta cells Each islet is composed of beta cells that secrete insulin and amylin, alpha cells that secrete glucagon, and delta cells that secrete somatostatin. In addition, at least one other type of cell, the PP cell, is present in small numbers in the islets and secrets a hormone of uncertain function called pancreatic polypeptide.

The diabetes nurse educator is teaching a community education class for new diabetics. Which of these does the nurse include in the discussion of signs and symptoms of hyperglycemia? Select all that apply.

Blurred vision Weight loss Thirst The most commonly identified signs and symptoms of diabetes are polydipsia, polyuria, and polyphagia. Other symptoms include weight loss, blurred vision, fatigue, and skin infections, especially candida in women.

When caring for the client with diabetic ketoacidosis, the nurse recognizes that fatty acids and ketones may be used for energy by most organs. Which organ does the nurse recognize is reliant on glucose as the major energy source?

Brain Although many tissues and organ systems are able to use other forms of fuel, such as fatty acids and ketones, the brain and nervous system rely almost exclusively on glucose as a fuel source. Because the brain can neither synthesize nor store more than a few minutes' supply of glucose, normal cerebral function requires a continuous supply from the circulation.

A client with diabetes mellitus has sudden onset of slurred speech, incoordination, and cool, clammy skin. What will the nurse do first?

Check blood glucose Hypoglycemia is a medical emergency. Because other conditions can also cause these symptoms, the blood glucose level should be checked first. Then glucose should be given. The client should follow this with a protein and complex carbohydrate to avoid a recurrence of hypoglycemia. Blood glucose should be tested about 15 minutes after the glucose is given to monitor progress.

Type 1A diabetes is now considered an autoimmune disorder. What factors are considered necessary for type 1A diabetes to occur?

Genetic predisposition, environmental triggering event, and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen Type 1A diabetes is thought to be an autoimmune disorder resulting from a genetic predisposition (i.e., diabetogenic genes); an environmental triggering event, such as an infection; and a T-lymphocyte-mediated hypersensitivity reaction against some beta-cell antigen.

The nurse is caring for a client who received regular insulin at 7 am. Four hours later the nurse finds the client diaphoretic, cool, and clammy. Which of these interventions is the priority?

Give the client a concentrated carbohydrate. The client is displaying symptoms of hypoglycemia, which include headache, difficulty in problem solving, altered behavior, coma, and seizures. Hunger may occur. Activation of the sympathetic nervous system may cause anxiety, tachycardia, sweating, and cool and clammy skin.

A 62-year-old man who is overweight has just been diagnosed with type 2 diabetes. The nurse educator is instructing him in the ways his diabetes can be controlled. The nurse should initially prioritize which action?

Helping the client make meaningful changes to his diet and activity level. Weight loss and dietary management are the initial focus of treatment for type 2 diabetes. For many people with type 2 diabetes, the benefits of exercise include a decrease in body fat, better weight control, and improvement in insulin sensitivity. If good glycemic control cannot be achieved with exercise and diet, then antidiabetic agents and even insulin can be added to the treatment plan. Education is imperative, but there is no need to emphasize hypoglycemia, since the client will not be using insulin initially.

During periods of fasting and starvation, the glucocorticoid and other corticosteroid hormones are critical for survival because of their stimulation of gluconeogenesis by the liver. When the glucocorticoid hormones remain elevated for extended periods of time, what can occur?

Hyperglycemia In predisposed persons, the prolonged elevation of glucocorticoid hormones can lead to hyperglycemia and the development of diabetes mellitus and starvation. They stimulate gluconeogenesis by the liver, sometimes producing a 6- to 10-fold increase in hepatic glucose production. A prolonged increase in glucocorticoid hormones does not cause hepatomegaly, portal hypertension, or adrenal hyperplasia.

***A 30-year-old man who manages his type 1 diabetes with glyburide presents at the emergency room reporting headache, confusion, and tachycardia. He has come from a party at which he drank two beers to celebrate running his first half marathon. Which phenomenon is likely to be the cause of his symptoms?

Hypoglycemia In hypoglycemia, headache, difficulty in problem solving, disturbed or altered behavior, coma, and seizures may occur. At the onset, activation of the parasympathetic nervous system often causes hunger, and the initial parasympathetic response is followed by activation of the sympathetic nervous system; this causes anxiety, tachycardia, sweating, and constriction of the skin vessels (i.e., the skin is cool and clammy). In diabetic ketoacidosis, the client typically has a history of 1 or 2 days of polyuria, polydipsia, nausea, vomiting, and marked fatigue. Abdominal pain and tenderness may be experienced without abdominal disease, and the breath has a characteristic fruity smell. The most prominent manifestations of hyperosmolar hyperglycemic state are dehydration and neurologic signs, including grand mal seizures, hemiparesis, Babinski reflexes, aphasia, muscle fasciculations, hyperthermia, hemianopia, nystagmus, and visual hallucinations; the client will also experience excessive thirst. The Somogyi effect describes a cycle of insulin-induced posthypoglycemic hyperglycemic episodes.

A client is managing diabetes with exercise and diet. The health care provider reviews the client's most recent laboratory results: fasting blood glucose level at 80 mg/dL (4.44 mmol/L) and a hemoglobin A1C of 5% (0.05). Select the response that best identifies the client.

The client is achieving normal glycemic control. The reading for the fasting blood glucose is appropriate, and the hemoglobin A1C level estimates good control of glucose levels over a 6- to 12-week period. This client should continue the exercise and diet routine as planned.

***When educating a client about glargine, the nurse should explain that this medication:

has a prolonged absorption rate and provides a relatively constant concentration for 12-24 hours. Glargine is long-acting insulin that has a slow, prolonged absorption rate and provides a relatively constant concentration over 12-24 hours. Rapid acting insulin has a rapid onset and peaks in about 5 minutes after injection. Short acting insulin will have a peak effect within 30 minutes, and thus it can be taken after a meal. Intermediate-acting insulin is a combination with short acting insulin so it is safe to take anytime throughout the day.