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Questions and Answers
A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms? (Select all that apply)
A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms? (Select all that apply)
- Cool, moist skin (correct)
- Dry skin
- Coma (correct)
- Confusion (correct)
Which oral antidiabetic agent helps tissues use available insulin more efficiently?
Which oral antidiabetic agent helps tissues use available insulin more efficiently?
- Glipizide
- Metformin (correct)
- Glyburide
- Repaglinide
What may be a potential cause of hypoglycemia in a patient diagnosed with diabetes mellitus?
What may be a potential cause of hypoglycemia in a patient diagnosed with diabetes mellitus?
The patient has not consumed food and continues to take insulin or oral antidiabetic medications.
Which insulin is used for basal dosage?
Which insulin is used for basal dosage?
Based on a client's history of unstable blood glucose levels, which health care worker should he be referred to?
Based on a client's history of unstable blood glucose levels, which health care worker should he be referred to?
By what time should a client receiving insulin lispro ensure they have breakfast?
By what time should a client receiving insulin lispro ensure they have breakfast?
What should be included in the teaching plan for a patient receiving glargine (Lantus)?
What should be included in the teaching plan for a patient receiving glargine (Lantus)?
A glucose challenge test should be performed between 24 to 28 weeks for gestational diabetes.
A glucose challenge test should be performed between 24 to 28 weeks for gestational diabetes.
What early signs and symptoms associated with hypoglycemia should the nurse monitor for?
What early signs and symptoms associated with hypoglycemia should the nurse monitor for?
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Study Notes
Hypoglycemia in Diabetes
- Blood glucose level of 45 mg/dl indicates hypoglycemia; signs include anxiety, confusion, headache, and cool, moist skin.
- Other symptoms of hypoglycemia: restlessness, irritability, diaphoresis, tremors, coma, and seizures.
- Diabetic ketoacidosis (DKA) signs: Kussmaul's respirations, dry skin, hypotension, bradycardia.
- Classic signs of diabetes mellitus: polyuria, polydipsia, polyphagia, and weight loss.
Oral Antidiabetic Agents
- Metformin, a biguanide, is effective in increasing insulin efficiency in tissues.
- Thiazolidinediones (e.g., rosiglitazone and pioglitazone) also act as insulin sensitizers.
- Sulfonylureas (glyburide, glipizide) and meglitinide (repaglinide) stimulate insulin release from the pancreas.
Causes of Hypoglycemia
- Hypoglycemia can occur when a diabetes patient does not eat but continues insulin or oral antidiabetic medications.
- Non-compliance with medication does not typically lead to hypoglycemia; eating without taking insulin may increase the risk of DKA.
Insulin Types for Basal Dosage
- Glargine (Lantus) is used for basal insulin dosing, providing a stable level.
- NPH insulin is intermediate-acting and usually administered after meals.
- Rapid-acting insulins: Humalog and Novolog.
Diabetes Management and Referrals
- Clients with type 1 diabetes experiencing unstable glucose levels should be referred to a dietitian for better control.
- No need for referrals to home health, psychiatric services, or social workers if not indicated.
Insulin Administration Timing
- Insulin lispro onset is 5 to 15 minutes; breakfast should be served by 7:45 AM to prevent hypoglycemia after a 7:30 AM injection.
Glargine (Lantus) Instruction
- Glargine should not be mixed with other insulins due to its pH of 4, which can cause precipitation.
- It is "peakless," absorbed slowly over 24 hours, and administered once daily.
Gestational Diabetes Testing
- A glucose challenge test is recommended between 24 to 28 weeks of pregnancy.
- Affects 2 to 5% of pregnancies and typically arises in the second or third trimester.
- Associated with increased risks for perinatal complications.
Monitoring After Intubation in Asthma Patients
- Following intubation in status asthmaticus, hourly blood glucose monitoring is critical.
- Early hypoglycemia signs include sweating, tremors, and tachycardia.
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