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Questions and Answers
What is a major disadvantage of using sliding-scale insulin dosing?
In which situation is sliding-scale insulin dosing typically used?
How much regular insulin will Mark receive if his blood glucose level is 15.2 mmol/L before lunch?
Which rapid-acting insulins are mentioned as being part of the sliding scale protocol?
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What is the purpose of adjusting subcutaneous insulin according to blood glucose levels?
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What is the preferred method of treatment for hospitalized patients with diabetes?
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Which insulin type is classified as a long-acting insulin?
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What is a potential complication that occurs due to continuous use of the same injection site for insulin?
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Which of these factors is indicative of the Somogyi effect?
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What should a nurse monitor for when a patient has received regular insulin subcutaneously?
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What is a characteristic of continuous glucose monitors (CGMs)?
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At which time should the nurse monitor a patient who received regular insulin 10 units at 0930 hours for signs of hypoglycemia?
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How much insulin in mL should a nurse draw for a dose of 30 units, if the insulin is available in a concentration of 50 units/mL?
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Which category of glycemic index (GI) foods should be consumed most frequently?
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What is the impact of high GI foods on blood glucose levels?
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Which of the following is NOT included in carbohydrate counting?
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What is the recommended dietary allowance (RDA) for available carbohydrates for adults?
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Which of the following recommendations is part of Diabetes Canada's guidelines?
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What is the correct sequence for mixing two types of insulin in one syringe?
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Which of the following is true regarding the administration of oral antidiabetic drugs?
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What is the primary role of patient education in diabetes management?
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Which sign indicates that a patient may be experiencing hypoglycemia?
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What action should be taken if a patient shows signs of hypoglycemia and is not alert enough to swallow?
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Which medication may need to be held on the day of surgery due to possible renal effects?
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What is the recommended action prior to administering insulin?
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Which is a common sign of later-stage hypoglycemia?
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What is the purpose of rolling insulin vials between hands when mixing suspensions?
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In what condition might insulin requirement increase?
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What is the recommended percentage of daily energy intake from carbohydrates for individuals with diabetes?
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Which of the following nutrients should be limited to less than 10% of daily energy intake for individuals with diabetes?
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In terms of meal timing, how should alcohol intake be managed for individuals with diabetes?
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What is the role of HbA1c in diabetes management?
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Which of the following is a major focus of nutritional therapy for diabetes management?
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How does the glycemic index (GI) affect blood glucose levels?
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What is the suggested protein energy intake percentage for individuals with diabetes?
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Which type of healthcare professionals are recommended to be part of the diabetes management team?
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What is the effect of nutritional therapy on HbA1c levels during the initial stages of diabetes?
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What is the recommended daily intake of fiber for individuals with diabetes?
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Study Notes
Insulin Administration
- Subcutaneous rapid-acting insulin (lispro or aspart) or short-acting insulin (regular) are adjusted according to blood glucose test results.
- Sliding-scale Insulin Dosing is typically used for hospitalized diabetic patients or those receiving total parenteral or enteral nutrition.
- Insulin doses increase as blood glucose increases.
- Recent research does not support sliding-scale use, however, it is still commonly used.
- Basal-Bolus Insulin Dosing is the preferred method for hospitalized patients with diabetes.
- Mimics a healthy pancreas by delivering basal insulin constantly and bolus insulin as needed.
- Basal insulin is long-acting (insulin glargine) and bolus insulin is rapid-acting (insulin lispro or insulin aspart.)
- Insulin Pump is a battery-operated device delivering continuous subcutaneous insulin infusion.
- Continuous Glucose Monitors (CGM) measure glucose levels in the extracellular fluid (ECF).
- Not insulin pumps! Insulin pumps have tubing and administer insulin.
- Complications of Insulin Therapy:
-
Hypoglycemia: Low blood glucose (less than 4mmol/L).
- Adrenergic symptoms include anxiety, tremors, hunger, palpitations, and sweating.
- Central nervous system symptoms include difficulty concentrating, confusion, weakness, drowsiness, vision changes, difficulty speaking, dizziness, and headache.
- Later signs include hypothermia, seizures, coma, and death.
- Allergic Reaction: To additives in insulin.
- Lipodystrophy: Accumulation of adipose tissue due to continuous insulin injections in the same site.
- Somogyi Effect: Rebound hyperglycemia and ketosis caused by an overdose of insulin.
- Usually occurs during sleep, with counterregulatory hormones released in response.
- Dawn Phenomenon: Characterized by hyperglycemia upon awakening in the morning, especially in adolescents.
- Due to the release of counterregulatory hormones in the predawn hours.
- Growth hormone/cortisol may play a role.
Oral Antidiabetic Drugs
- Used for type 2 diabetes.
- Diabetes Canada (2018) recommends for new-onset type 2 diabetes with an A1C of 14 mmol/L.
- Therapy may involve one or more drugs.
- Treatment of associated comorbidities.
- Thorough patient education is essential regarding:
- Disease process.
- Diet and exercise recommendations.
- Self-administration of insulin or oral drugs.
- Potential complications.
- Insulin requirements may increase during periods of severe stress, such as illness or surgery.
Nursing Implications
- When insulin is ordered, ensure:
- Correct drug.
- Correct route.
- Correct type of insulin.
- Correct dosage.
- Insulin order and prepared dosages should be second-checked with another registered nurse (or per agency policy).
- Insulin Administration:
- Check blood glucose level before giving insulin.
- To mix suspensions, roll vials between hands instead of shaking them.
- Ensure correct storage of insulin vials.
- Only use insulin syringes, calibrated in units, to measure and give insulin.
- Ensure correct timing of insulin dose with meals.
- When mixing two types of insulin in one syringe, always withdraw the regular or rapid-acting (clear) insulin first.
- Provide thorough patient education regarding self-administration.
- Oral Antidiabetic Drug Administration:
- Always check blood glucose levels before administering.
- Usually given 30 minutes before meals.
- α-Glucosidase inhibitors are given with the first bite of each main meal.
- Metformin is taken with meals to reduce gastrointestinal effects.
- Patients undergoing surgery or radiological procedures requiring contrast medium should hold their metformin on the day of surgery and for 48 hours postoperatively.
- Possible renal effects.
- Begin metformin only after serum creatinine has been checked and is normal.
- Communication with provider is essential.
Hypoglycemia Treatment
- Assess for signs of hypoglycemia.
- At the first sign: Check blood glucose.
- If 4 mmol/L, investigate further for the cause of the signs or symptoms.
- If monitoring equipment is not available, treatment should be initiated.
- If alert enough to swallow:
- 15–20 g of a simple carbohydrate like regular soft drink or six Life-saver candies.
- Recheck blood sugar 15 minutes after treatment.
- Repeat until blood sugar >4 mmol/L.
- Patient should eat a regularly scheduled meal or snack to prevent rebound hypoglycemia.
- Check blood sugar again 45 minutes after eating the snack.
- If patient is not alert enough to swallow:
- Administer 1 mg of glucagon IM or SC.
- Adverse effect: rebound hypoglycemia.
- Have the patient ingest a complex carbohydrate after recovery.
- In acute care settings:
- 20–50 mL of 50% dextrose IV push.
- Check blood sugar again 45 minutes after eating the snack.
Nursing Implications
- Monitor therapeutic response.
- Decrease in blood glucose levels to the prescribed level.
- Measure HbA1c to monitor long-term compliance with diet and drug therapy.
- Watch for and monitor hypoglycemia and hyperglycemia.
Diabetes Nutrition
- Nutritional therapy is the cornerstone of care for people with DM.
- Nutrition is also the most challenging aspect of diabetes management.
- Nutritional therapy can reduce A1C by an absolute 1 to 2% with the greatest impact at the initial stages of DM.
- How a person eats is as important as what they eat.
- Regular distribution of carbohydrates.
- Replacing high-glycemic index carbohydrates is clinically beneficial.
- Timing of alcohol intake with food.
- Achieving nutritional goals requires a coordinated team effort that takes into account the behavioral, cognitive, socioeconomic, cultural, and spiritual aspects of the person.
- A DM nurse educator and a registered dietitian with expertise in DM management should be members of the team.
Food Composition
- DM is a general metabolic disorder involving three categories of energy-providing nutrients:
- Carbohydrates.
- Fats.
- Proteins.
- Nutritional energy intake should be constantly balanced with the energy output of the individual, taking into account exercise and metabolic work of the body.
General Recommendations for Nutrient Balance
- Protein: 15 to 20% of energy.
- There is no evidence that usual protein intake (15–20% of energy) should be modified.
- Those with diabetic nephropathy should limit protein intake to 15% of energy and be monitored closely by a registered dietitian.
- Fat: Less than 35% of energy.
- Combined saturated fats and trans-fatty acids should be reduced to less than 9% of energy intake.
- Polyunsaturated fat should be limited to less than 10% of energy intake.
- Foods rich in polyunsaturated omega-3 fatty acids and plant-based fats should be encouraged.
- Fibre: Approximately 30 to 50 g/day from a variety of food sources, including soluble and cereal fibres.
- Carbohydrates: 45 to 60% of energy.
- Carbohydrates should include whole grains, fruits, vegetables, and low-fat milk.
- Patients should try to consume higher-fibre sources of carbohydrate.
- Less than 10% of daily energy should come from sucrose (sugar).
- Low-carbohydrate diets are not recommended.
Glycemic Index (GI)
- Describes the rise in blood glucose levels after consuming carbohydrate-containing foods.
- A GI of 100 refers to the response to 50 g of glucose or white bread in a normal person without DM.
- All other food with an equivalent carbohydrate value is measured against this standard.
- Foods with a high GI increase blood sugar higher and faster than foods with a low GI.
- Low GI (55 or less).
- Medium GI (56-69).
- High GI (70 or more).
- Eat foods in the low GI category most often, the medium category less often, and the high GI category the least often.
Complex vs.Simple Carbs
- Foods with a high GI (e.g., potatoes, white bread) will cause a sharp rise in blood glucose, whereas foods with a low GI (e.g., brown rice) will steadily increase blood glucose over a longer period.
-
Low GI Eating
- Reduces hypoglycemia.
- Improves total cholesterol.
- Improves overall glycemic control.
Carbohydrate Counting
- Includes starches and sugar but not fiber.
- The dietary reference intakes (DRIs) specify a recommended dietary allowance (RDA) for available CHO of no less than 130 g/day for adult women and men >18 years of age to provide glucose to the brain.
Diabetes Canada Recommendations
- Eat three meals per day at regular times and eat at intervals no more than 6 hours apart.
- Limit sugars and sweets (sugar, regular pop, desserts, candies, jam, and honey).
- Limit the amount of high-fat food (fried foods, chips, and pastries).
- Eat more high-fiber foods (whole-grain breads and cereals, lentils, dried beans and peas, brown rice, fruits, and vegetables).
- Drink water if thirsty.
- Add physical activity to the lifestyle.
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Description
This quiz covers various insulin administration methods including sliding-scale dosing, basal-bolus therapy, insulin pumps, and the use of continuous glucose monitors. It aims to enhance understanding of these techniques and their relevance in managing diabetes. Test your knowledge on the best practices for insulin delivery in clinical settings.
