A 26-year-old female with type 1 diabetes develops a sore throat ...

[anjilletteb]

A 26-year-old female with type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler.
 
  The patient calls the clinic for advice about her symptoms and a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. The nurse advises the patient to
  a. use only the lispro insulin until the symptoms are resolved.
  b. limit intake of calories until the glucose is less than 120 mg/dL.
  c. monitor blood glucose every 4 hours and notify the clinic if it continues to rise.
  d. decrease intake of carbohydrates until glycosylated hemoglobin is less than 7.

Question 2

An unresponsive patient with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the need to
 
  a. give a bolus of 50 dextrose.
  b. insert a large-bore IV catheter.
  c. initiate oxygen by nasal cannula.
  d. administer glargine (Lantus) insulin.

[heinisk01]

Answer to Question 1

ANS: C
Infection and other stressors increase blood glucose levels and the patient will need to test blood glucose frequently, treat elevations appropriately with lispro insulin, and call the health care provider if glucose levels continue to be elevated. Discontinuing the glargine will contribute to hyperglycemia and may lead to diabetic ketoacidosis (DKA). Decreasing carbohydrate or caloric intake is not appropriate because the patient will need more calories when ill. Glycosylated hemoglobin testing is not used to evaluate short-term alterations in blood glucose.

Answer to Question 2

ANS: B
HHS is initially treated with large volumes of IV fluids to correct hypovolemia. Regular insulin is administered, not a long-acting insulin. There is no indication that the patient requires oxygen. Dextrose solutions will increase the patient's blood glucose and would be contraindicated.

[anjilletteb]

Excellent

[dantucker]

Gracias!