TYPE 1 DIABETES

The nurse is preparing patients newly diagnosed with diabetes mellitus (DM) for discharge from an acute care facility. What should the nurse include in patient teaching regarding medications to treat DM? 1. Patients with type 1 diabetes may achieve normal blood glucose levels with oral medications. 2. Type 1 diabetes may progress to type 2 if blood glucose levels are not well controlled. 3. Patients with type 1 diabetes will always need an exogenous source of insulin. 4. Patients with type 2 diabetes generally need a combination of oral medications and insulin to achieve normal blood glucose levels.

3. Rationale 3: The person with type 1 DM requires a lifelong exogenous source of insulin to maintain life.

The nurse is planning a presentation to a community group on diabetes mellitus. The nurse should include information about which possible etiology for type 1 diabetes? 1. Inflammatory disorder 2. Infectious disorder 3. Autoimmune disorder 4. Drug-induced disorder

3. Rationale 3: Type 1 diabetes, formerly called insulin-dependent or juvenile diabetes, is caused by an autoimmune process.

A client is diagnosed with the type of diabetes in which the plasma beta cells fail to respond to insulin. Which type of diabetes is this client experiencing? 1. Gestational diabetes 2. Impaired glucose tolerance 3. Type 1 diabetes mellitus 4. Type 2 diabetes mellitus

3. Type 1 diabetes mellitus results from a defect or failure of the beta cells of the pancreas. The loss of beta cells causes a lack of insulin. The other options produce insulin.

The nurse is preparing a teaching plan for a client who is newly diagnosed with Type 1 diabetes mellitus. Which signs and symptoms should the nurse describe when teaching the client about hypoglycemia? A. Sweating, trembling, tachycardia. B. Polyuria, polydipsia, polyphagia. C. Nausea, vomiting, anorexia. D. Fruity breath, tachypnea, chest pain.

A. Sweating, trembling, tachycardia.

When teaching the patient with type 1 diabetes, what should the nurse emphasize as the major advantage of using an insulin pump? a. Tight glycemic control can be maintained. b. Errors in insulin dosing are less likely to occur. c. Complications of insulin therapy are prevented. d. Frequent blood glucose monitoring is unnecessary

A. Insulin pumps provide tight glycemic control by continuous subcutaneous insulin infusion based on the patient's basal profile, with bolus doses at mealtime at the patient's discretion and related to blood glucose monitoring. Errors in insulin dosing and complications of insulin therapy are still potential risks with insulin pumps.

In type 1 diabetes there is an osmotic effect of glucose when insulin deficiency prevents the use of glucose for energy. Which classic symptom is caused by the osmotic effect of glucose? a. Fatigue b. Polydipsia c. Polyphagia d. Recurrent infections

B. Polydipsia is caused by fluid loss from polyuria when high glucose levels cause osmotic diuresis. Cellular starvation from lack of glucose and the use of body fat and protein for energy contribute to fatigue, weight loss, and polyphagia in type 1 diabetes.

The patient with type 1 diabetes mellitus is in the clinic to check his long-term glycemic control. Which test should be used? a. Water deprivation test b. Fasting blood glucose test c. Oral glucose tolerance test d. Glycosylated hemoglobin (A1C)

D. Glycosylated hemoglobin (A1C) is used to assess blood glucose control during the previous 3 months. Water deprivation (ADH stimulation) is used to differentiate causes of diabetes insipidus. Fasting blood glucose will measure only the current blood glucose result. The oral glucose tolerance test is used to diagnose diabetes when abnormal fasting blood glucose levels do not clearly indicate diabetes.

The nurse explains to a newly diagnosed type 1 diabetic that the beta cells can no longer produce adequate insulin because: a. they are inhibited by pituitary disorder. b. an allergic response has altered their response to hyperglycemia. c. alpha cells have proliferated in the islets of Langerhans. d. the bodys immune system has destroyed them.

D. In type 1 diabetes mellitus (DM), the beta cells on the islets of Langerhans are destroyed by an autoimmune reaction.

The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following? a. I can have an occasional alcoholic drink if I include it in my meal plan. b. I will need a bedtime snack because I take an evening dose of NPH insulin. c. I can choose any foods, as long as I use enough insulin to cover the calories. d. I will eat something at meal times to prevent hypoglycemia, even if I am not hungry

c. Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who are using intensified insulin therapy have considerable flexibility in diet choices but still should restrict dietary intake of items such as fat, protein, and alcohol. The other patient statements are correct and indicate good understanding of the diet instruction.

Which teaching, included in the plan of care for a patient who has type 1 diabetes mellitus, would be most effective in reducing the development of complications? 1. Self-monitoring of blood glucose levels 2. Effective foot care 3. Importance of early eye exam 4. Avoidance of simple carbohydrates in the diet

1. Rationale 1: Frequent monitoring of blood glucose levels facilitates necessary adjustments in diet, physical activity, and pharmacologic therapy.

A patient has been recently diagnosed with type 1 diabetes mellitus. The patient states, I am thin and eat all the time. How can I have diabetes? Which response by the nurse is most appropriate? 1. Thin people can be diabetic, too. 2. Your condition makes it impossible for you to gain weight. 3. People with type 1 diabetes are usually thin or of normal weight at diagnosis. 4. Your lab tests indicate the presence of diabetes.

3. Rationale 3: The diabetic patient is unable to obtain the needed glucose for the bodys cells, due to the lack of insulin. Patients diagnosed with type 1 diabetes mellitus experience polyphagia and are often thin.

The nurse is caring for a patient who has a diagnosis of diabetes mellitus type 1. Which finding would best indicate that the patient is at risk for developing diabetic ketoacidosis? 1. Reports of anxiety 2. Tremors 3. Nausea and vomiting 4. Extreme hunger

3. Rationale 3: Nausea and vomiting are thought to result from the accumulation of serum ketones.

The nurse is teaching a patient with newly diagnosed type 1 diabetes about the required diet for managing the disorder. Which information should the nurse include? 1. Do not consume alcoholic beverages. 2. Restrict the carbohydrates in your diet. 3. Eat whenever you feel hungry. 4. Select carbohydrates such as whole grains or legumes.

4. Rationale 4: Complex carbohydrates such as whole grains, legumes, fruits, and those with low glycemic indices will limit spikes in blood glucose values.

A client with type 1 diabetes mellitus is instructed by the physician to obtain glucagon hydrochloride (Glucagon) for emergency home use. The nurse provides information to the client's wife about the medication. Which statement by the client's wife indicates that she understands the information? A. "I need to store this medication in the freezer." B. "I know that this is used to treat episodes of high blood sugar." C. "I can give this medication instead of insulin if his insulin runs out." D. "I need to give this if he has signs of low blood sugar and goes into a coma."

D. "I need to give this if he has signs of low blood sugar and goes into a coma."

A 38-year-old patient who has type 1 diabetes plans to swim laps daily at 1:00 PM. The clinic nurse will plan to teach the patient to a. check glucose level before, during, and after swimming. b. delay eating the noon meal until after the swimming class. c. increase the morning dose of neutral protamine Hagedorn (NPH) insulin. d. time the morning insulin injection so that the peak occurs while swimming.

a. The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, patients are advised to eat before exercising. Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise.