Drugs for Diabetes Mellitus

The nurse is initiating discharge teaching with the newly diagnosed client with diabetes. Which of the following statements indicates that the client needs additional teaching?

"I must draw the NPH insulin first if I am mixing it with regular insulin"

A patient with type 2 diabetes on metformin (Glucophage) reports that he takes propranolol (Inderal) for his hypertension. What concerns would the nurse have about this combination of medications and what would the nurse teach the patient?

Beta blocking drugs such as propranolol have the potential to alter the way hypoglycemia is perceived and the normal "alarm" symptoms may be subtle. Diaphoresis is a common symptom when blood glucose decreases among those patients on beta blockers along with their oral anti diabetic drug. The nurse should teach the patient to be aware that should his blood glucose begin to decrease, symptoms normally felt (e.g., nervousness, tremors, agitation) may be perceived differently, and that should sweating occur, he should check his blood sugar immediately.

A client with type 2 diabetes has been NPO since midnight for surgery in the morning. He has been on combination of oral type 2 anti diabetic drugs. What would be the best action for the nurse to take concerning the administration of his medication?

Contact the health care provider for further orders.

The patient has insulin glargine (Lantus) and regular insulin ordered for every morning. Explain the implications of administering these two types of insulins.

Insulin glargine (Lantus) is a newer agent that is recombinant human insulin analog. It must not be mixed in the syringe with any other insulin and must be administered SQ. Insulin glargine appears to have a constant long-duration hypoglycemic effect with no defined peak effect. Instead, it appears to maintain a consistent level of insulin activity throughout its duration. The nurse should verify the order with the health care provider. Insulin glargine (Lantus) is often prescribed to be given at bedtime. The order for the morning administration should be checked. The morning dose of regular insulin may provide additional coverage for the morning meal until a morning dose of Lantus begins to have activity, but if the Lantus is switched to a bedtime dose, additional regular insulin in the morning may not be needed.

A 63 year old client with type 2 diabetes is admitted to the nursing unit with infected foot ulcer. Despite previous good control on glyburide (Mircronase), his blood glucose has been elevated the past several days and he requires sliding-scale insulin. What is the most likely reason for the elevated glucose levels?

It is a temporary condition related to the stress response with increased glucose release.

The client is scheduled to receive 5 units of Humalog and 25 units of NPH (Isophane) insulin prior to breakfast. Which nursing intervention is most appropriate for this client?

Make sure the client's breakfast is available to eat before administering this insulin.

A 28 year old woman who is pregnant with her first child is diagnosed with gestational DM. She is concerned about the fact that she might have to take "shots". She tells the nurse at the public health clinic that she does not think she can self-administer an injection and asks if there is a pill that will control her blood sugar. She has heard her grandfather talk about his pills to control his "sugar". What should the nurse explain to this patient?

The nurse should explain that the management of gestational diabetes includes dietary management, regular exercise, and home blood glucose monitoring. Based on her glucose levels, insulin may be required but not all patients require insulin throughout the entire pregnancy. Recent research suggests that some oral anti diabetic drugs may be used safely during pregnancy. her obstetrician and health care provider or endocrinologist will work with her to determine the most appropriate treatment. Should insulin injections be required, she will be given multiple opportunities for practice, and discomfort during an injection is usually minimal.

A client receives NPH and regular insulin every morning. The nurse is verifying that the client understands that there are two different peak times to be aware of for this insulin regimen. Why is this an important concept for the nurse to stress?

The risk for hypoglycemia is greater around the peak of insulin activity.

What client education should the nurse provide to the client with diabetes who is planning an exercise program?

monitor blood glucose levels before and after exercise; eat a complex carbohydrate prior to strenuous exercise