HYPOGLYCEMIA

cold & clammy =

need some candy

one way to become hypogylcemic is by

too much insulin or too many pills/medication

The nurse is providing instruction to a group of patients who are planning to participate in an athletic triathlon. Each member of the group has been diagnosed with either diabetes mellitus type 1 or type 2. A member of the group asks, If we each follow our usual daily diabetic control routine, which diabetic complication is most likely to occur during this event? What is the nurses best answer? 1. Diabetic ketoacidosis 2. Hypoglycemia 3. Hyperosmolar hyperglycemic state 4. Impaired glucose tolerance

2. Rationale 2: Severe hypoglycemia often results from too much insulin, too little food, or too much exercise.

A client diagnosed with type 1 diabetes mellitus administers a dose of NPH insulin at 7:00 a.m. At which of the following times would this client exhibit hypoglycemia? 1. 0800 (8am) 2. 0900 (9am) 3. 1000 (10 am ) 4. 1400 (2pm)

4. NPH insulin peaks in 4 to 12 hours. During these hours, the client may experience a hypoglycemic episode. The other choices identify times that are before the peak times for the insulin.

Priority Decision: Two days following a self-managed hypoglycemic episode at home, the patient tells the nurse that his blood glucose levels since the episode have been between 80 and 90 mg/dL. Which is the best response by the nurse? a. "That is a good range for your glucose levels." b. "You should call your health care provider because you need to have your insulin increased." c. "That level is too low in view of your recent hypoglycemia and you should increase your food intake." d. "You should take only half your insulin dosage for the next few days to get your glucose level back to normal."

A. Blood glucose levels of 80 to 90 mg/dL (4.4 to 5 mmol/L) are within the normal range and are desired in the patient with diabetes, even following a recent hypoglycemic episode. Hypoglycemia is often caused by a single event, such as skipping a meal, taking too much insulin, or vigorous exercise. Once corrected, normal glucose control should be maintained.

A 72-year-old woman is diagnosed with diabetes. What does the nurse recognize about the management of diabetes in the older adult? a. It is more difficult to achieve strict glucose control than in younger patients. b. Treatment is not warranted unless the patient develops severe hyperglycemia. c. It does not include treatment with insulin because of limited dexterity and vision. d. It usually requires that a younger family member be responsible for care of the patient.

A. Older adults have more conditions that may be treated with medications that impair insulin action. Hypoglycemic unawareness is more common, so these patients are more likely to suffer adverse consequences from blood glucose-lowering therapy. Clinical manifestations of long-term complications of diabetes take 10 to 20 years to develop, so the goals for glycemic control are not as rigid as in the younger population. Treatment is indicated and insulin may be used if the patient does not respond to oral agents. The patient's needs rather than age determine the responsibility of others in care.

Individualized nutrition therapy for patients using conventional, fixed insulin regimens should include teaching the patient to: a. eat regular meals at regular times. b. restrict calories to promote moderate weight loss. c. eliminate sucrose and other simple sugars from the diet. d. limit saturated fat intake to 30% of dietary calorie intake.

A. The body requires food at regularly spaced intervals throughout the day, and omission or delay of meals can result in hypoglycemia, especially for the patient using conventional insulin therapy or OAs. Weight loss may be recommended in type 2 diabetes if the individual is overweight, but many patients with type 1 diabetes are thin and do not require a decrease in caloric intake. Fewer than 7% of total calories should be from saturated fats and simple sugar should be limited, but moderate amounts can be used if counted as a part of total carbohydrate intake.

A diabetic nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote? A) Always carry a form of fast-acting sugar. B) Perform exercise prior to eating whenever possible. C) Eat a meal or snack every 8 hours. D) Check blood sugar at least every 24 hours.

A. The following teaching points should be included in information provided to the patient on how to prevent hypoglycemia: Always carry a form of fast-acting sugar, increase food prior to exercise, eat a meal or snack every 4 to 5 hours, and check blood sugar regularly.

A patient with type 1 diabetes uses 20 U of Novolin 70/30 (NPH/regular) in the morning and at 6:00 PM. When teaching the patient about this regimen, what should the nurse emphasize? a. Hypoglycemia is most likely to occur before the noon meal. b. A set meal pattern with a bedtime snack is necessary to prevent hypoglycemia. c. Flexibility in food intake is possible because insulin is available 24 hours a day. d. Premeal glucose checks are required to determine needed changes in daily dosing.

B. A split-mixed dose of insulin requires that the patient adhere to a set meal pattern to provide glucose for the peak action of the insulin, and a bedtime snack is usually required when patients take an intermediate-acting insulin late in the day to prevent nocturnal hypoglycemia. Hypoglycemia is most likely to occur with this dose late in the afternoon and during the night. When premixed formulas are used, flexible dosing based on glucose levels is not recommended.

HYPERGLYCEMIA TREATMENT: CARBOHYDRATES

Cause needs to be determined Assess symptoms Review simple carbohydrates clients should have Between meal snacks Omit/ limit simple carbohydrates HYDRATE Yes hydrate Dehydration prevention Rehydrate with 4 oz sugar w noncaffeinated liquid every ½ hr when sick Assess client's understanding of insulin/DM management Teach client to recognize signs Evaluate understanding with "teach back"

hypoglycemia manifestations:

Cool and clammy Shaky Sweaty/profuse perspiration Dizzy Hungry Anxious, irritable Weakness, fatigue Impaired vision Headache decreased Bp, increased HR, RR normal

The nurse reviews a patients glycosylated hemoglobin (Hb A1C) results to evaluate a. fasting preprandial glucose levels. b. glucose levels 2 hours after a meal. c. glucose control over the past 90 days. d. hypoglycemic episodes in the past 3 months.

D. Glycosylated hemoglobin testing measures glucose control over the last 3 months. Glucose testing before/after a meal or random testing may reveal impaired glucose tolerance and indicate prediabetes, but it is not done on patients who already have a diagnosis of diabetes. There is no test to evaluate for hypoglycemic episodes in the past.

An 18-year-old male patient with a small stature is scheduled for a growth hormone stimulation test. In preparation for the test, the nurse will obtain a. ice in a basin. b. glargine insulin. c. a cardiac monitor. d. 50% dextrose solution.

D. Hypoglycemia is induced during the growth hormone stimulation test, and the nurse should be ready to administer 50% dextrose immediately. Regular insulin is used to induce hypoglycemia (glargine is never given IV). The patient does not require cardiac monitoring during the test. Although blood samples for some tests must be kept on ice, this is not true for the growth hormone stimulation test.

Cause of Hypogylcemia

Not enough food Too much insulin/medication

The nurse cautions that the technique of tight control of hyperglycemia is not recommended for the older adult because the older adult: a. may not be able to test and administer sliding-scale insulin. b. is at a lower risk for hyperglycemia. c. is prone to cardiovascular problems resultant from hypoglycemia. d. has an unstable metabolic rate

C.

A patient with diabetes is found unconscious at home and a family member calls the clinic. After determining that a glucometer is not available, what should the nurse advise the family member to do? a. Have the patient drink some orange juice. b. Administer 10 U of regular insulin subcutaneously. c. Call for an ambulance to transport the patient to a medical facility. d. Administer glucagon 1 mg intramuscularly (IM) or subcutaneously

D. If a patient with diabetes is unconscious, immediate treatment for hypoglycemia must be given to prevent brain damage, and IM or subcutaneous administration of 1 mg of glucagon should be done. If the unconsciousness has another cause, such as ketosis, the rise in glucose caused by the glucagon is not as dangerous as the low glucose level. Following administration of the glucagon, the patient should be transported to a medical facility for further treatment and evaluation. Oral carbohydrates cannot be given when patients are unconscious, and insulin is contraindicated without knowledge of the patient's glucose level.