A 60-year-old man has long managed his type 1 diabetes ...

[sarasara]

A 60-year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration, and conscientious eating habits.
 
  This morning, however, his wife has noted that he appears pale and clammy and appears to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode. Which of the following actions should be the wife's first choice?
  A)
  Administration of 15 to 20 g of glucose in a concentrated carbohydrate source
  B)
  Administration of subcutaneous glucagon
  C)
  IV infusion of 50 dextrose and water solution
  D)
  Careful monitoring for level of consciousness and resolution of hypoglycemia

Question 2

A 30-year-old male who manages his type 1 diabetes with glyburide presents at the emergency room complaining of headache, confusion, and tachycardia. He has come from a party at which he drank two beers to celebrate running his first half-marathon.
 
  Which of the following is likely to be the cause of his complaints?
  A)
  Diabetic ketoacidosis
  B)
  Hyperosmolar hyperglycemic state
  C)
  Hypoglycemia
  D)
  Somogyi effect

[wshriver]

Answer to Question 1

Ans:
A

Feedback:

An insulin reaction necessitates intervention in addition to careful observation. The ideal response to an insulin reaction in a still, conscious client is the administration of 15 to 20 g of glucose in a concentrated carbohydrate source. Glucagon or D50 would be indicated if the client is unconscious or unable to swallow.

Answer to Question 2

Ans:
C

Feedback:

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.

[sarasara]

TYSM

[atrochim]

Excellent