Chapter 38: Agents to Control Blood Glucose Levels

The nurse has just completed discharge instructions to a client who will be using a pen device to deliver his insulin dose. What statement by the client indicates a need for further instruction?

"If I forget to take my insulin pen, I will be able to use the one that my wife uses." Insulin pens are client-specific because the needle may be used multiple times and may be contaminated with blood. Also, the pen is prefilled with a specific type of insulin. The client selects the desired units by turning a dial and listening for a locking ring. The insulin dose is determined by the number of clicks heard. It is a useful method for clients who have poor eyesight.

A client has been newly diagnosed with type 2 diabetes. What statement would be appropriate for the nurse to include in the teaching?

"Regular exercise makes your body better able to use the insulin it produces." Exercise is an extremely strong hypoglycemic agent, so the nurse should encourage the practice. Diabetics need to check their blood sugar level regardless of whether they are prescribed insulin. The need for insulin injections is determined by the function of the pancreas and its ability to produce sufficient quantities of insulin. It is not correct to assume diet is the only factor in this process. Alcohol should be avoided, and the dosage of oral antidiabetic medication should not be altered without guidance from a health care provider.

A nurse should monitor a client taking glimepiride (Amaryl) for which of adverse effects? (Select all that apply.)

-Hypoglycemia -Heartburn -Nausea Adverse reactions associated with sulfonylureas, like glimepiride (Amaryl), include hypoglycemia, anorexia, nausea, vomiting, epigastric discomfort, weight gain, heartburn, and various vague neurologic symptoms, such as numbness and weakness of the extremities.

The client is scheduled to get a breakfast tray at 07:00. At what time should the client receive a prescribed dose of insulin lispro?

06:45 With short-acting insulins like lispro, aspart, or glulisine, it is important to inject the medication about 15 minutes before eating.

A patient is taking chlorpropamide. The nurse warns the patient about the possibility of hypoglycemia within approximately which time frame after taking the drug?

3 to 4 hours Chlorpropamide peaks in 3 to 4 hours, which would be the time for possible hypoglycemia.

Which strategy will NOT increase the therapeutic effect of insulin?

All insulin should be stored in a refrigerator but never frozen. Store opened vials of regular insulin at room temperature. Extra supplies are stored in the refrigerator, not the freezer. Extreme temperatures (<2°C or >30°C) should be avoided to prevent the loss of maximum function. Administer regular insulin with an insulin syringe into an appropriate subcutaneous site. Regular insulin is administered about 30 to 60 minutes before eating. To promote regular absorption, one anatomic area should be selected for regular insulin injections (e.g., the abdomen). Frequent monitoring of blood glucose by fingersticks and periodic determinations of hemoglobin A1C levels help determine the therapeutic effect of insulin and overall consistency of diabetic control.

A female client visits the health care provider's office after routine labs are drawn. The nurse notes that her A1C is 9. How does the nurse interpret this finding?

Client's average blood glucose is above normal. The American Diabetes Association (ADA) suggests a target A1C of less than 7%. A1C should be measured every 3 to 6 months. An A1C of 9 indicates that the client's average blood glucose is consistently above normal.

The older diabetic client often experiences several different chronic organ related conditions. Which assessment should the nurse focus upon when attempting to manage this complex situation?

Drug interactions The older patient is more likely to experience end organ damage related to the diabetes—loss of vision, kidney problems, coronary artery disease, and infections—and the drug regimen of these patients can become quite complex. Careful screening for drug interactions is an important aspect of the assessment of these patients.

Insulin binds with and activates receptors on cell membranes. Once insulin-receptor binding occurs, the membranes become highly permeable to glucose. Which action does this enable?

Entry of glucose into the cells After insulin-receptor binding occurs, cell membranes become highly permeable to glucose and allow rapid entry of glucose into the cells.

What would alert the nurse to suspect that a client is developing ketoacidosis?

Fruity breath odor Fruity breath odor would be noted as ketones build up in the system and are excreted through the lungs. Dehydration would be noted as fluid and electrolytes are lost through the kidneys. Blurred vision and hunger would be associated with hypoglycemia.

The nurse is providing education to a client who has been prescribed therapy with an antidiabetic medication. During teaching, the nurse will caution the client against heavy intake of which herb?

Garlic has been known to cause hypoglycemia when taken with antidiabetic medications. Anise, basil, and oregano are not noted to carry this risk.

The health care provider has ordered a change of prescription from rapid-acting insulin to an intermediate-acting type. Which adverse effect must the nurse closely monitor for in the client?

Hypoglycemia Changing the type of insulin requires caution, and the client should be carefully monitored for hypoglycemia or hyperglycemia, either of which may occur as the body adjusts to the different pharmacokinetics of the preparation. However, hypoglycemia may cause an increased sympathetic activity and manifest as tachycardia. Lipodystrophy is caused by the breakdown of subcutaneous fat because of repeated insulin injections at the same site. A change of insulin prescription is not known to cause hypotension.

When administering insulin, what would be most appropriate?

Insert the needle at a 45-degree angle for injection. 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. The needle is inserted at a 45-degree angle for subcutaneous administration. Gentle pressure should be applied at the injection site.

A nurse at a health care facility is assigned to administer insulin to the patient. Which intervention should the nurse perform before administering each insulin dose?

Inspect the previous injection site for inflammation. The nurse should check the previous injection site before administering each insulin dose. The injection sites should be rotated to prevent lipodystrophy. Prefilled syringes should not be kept horizontally; they should be kept in a vertical or oblique position to avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when administration of metformin leads to lactic acidosis. Insulin should be kept at room temperature for administration. Insulin is refrigerated if it needs to be stored for up to three months for later use.

Which would be appropriate to include in teaching a client with type 2 diabetes?

It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. Exercise is perhaps the best therapy for the prevention of both type 2 diabetes and the metabolic syndrome. Exercise is an extremely strong hypoglycemic agent.

After teaching a class about the various drugs used to control blood glucose, the instructor determines that the teaching was successful when the class identifies what as a biguanide?

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

A nurse is caring for a patient with diabetes mellitus who is receiving an oral antidiabetic drug. Which of following ongoing assessments should the nurse perform when caring for this patient?

Observe the patient for hypoglycemic episodes. As the ongoing assessment activity, the nurse should observe the patient for hypoglycemic episodes. Documenting family medical history and assessing the patient's skin for ulcers, cuts, and sores on the body is a pre-administration assessment activity performed by the nurse. Lipodystrophy occurs if the sites of insulin injection are not rotated.

A client diagnosed with diabetic ketoacidosis has been admitted to the intensive care unit. The client is prescribed an intravenous insulin drip, so the nurse knows that what type of insulin will be administered?

Regular insulin (insulin injection) has a rapid onset of action and can be given intravenously. Therefore, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures. All the other options are administered subcutaneously.

A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse most likely administer?

insulin lispro Insulin lispro is an example of a rapid-acting insulin. Insulin glargine and insulin detemir are long-acting insulin. Isophane insulin suspension is an intermediate-acting insulin.

When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously?

regular Regular insulin (insulin injection) has a rapid onset of action and can be given intravenously. Therefore, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures. All the other options are administered subcutaneously.

The nurse is caring for a client who is taking insulin. The nurse suspects the client is experiencing hypoglycemia when the client displays what signs?

weakness, sweating, and decreased mentation. Symptoms of hypoglycemia include shakiness, dizziness or light-headedness, sweating, nervousness or irritability, sudden changes in behavior or mood, weakness, pale skin, and hunger. The other signs are more consistent with hyperglycemia.