Diabetes Q and A

A client is diagnosed as having insulin-dependent diabetes mellitus (IDDM). She received regular insulin at 7:30 A.M. When is she most apt to develop a hypoglycemic reaction? 1. Mid-morning 2. Mid-afternoon 3. Early evening 4. During the night ANSWER’ 1. Hypoglycemic reactions occur at peak action time. Peak action time for regular insulin is two to four hours after injection, which would be midmorning. An adolescent with IDDM is learning about a diabetic diet. He asks the nurse if he will ever be able to go out to eat with his friends again. What is the most appropriate answer for the nurse to give? 1. “You can go out with them, but you should take your own snack with you.” 2. “Yes. You will learn what foods are allowed so you can eat with your friends.” 3. “When you get food out in a restaurant, be sure to order diet soft drinks.” 4. “Eating out will not be possible on a diabetic diet. Why don’t you plan to invite your friends to your house?” ANSWER 2. Eating out with friends is very important to an adolescent. Snacks will be allowed on his diet. He should be taught how to use the exchange lists in managing his diet. At 10 A.M., a client with Type 1 diabetes becomes very irritable and starts to yell at the nurse. Which initial nursing assessment should take priority? 1. Blood pressure and pulse 2. Color and temperature of skin 3. Reflexes and muscle tone 4. Serum electrolytes and glucose ANSWER 2. The nurse should immediately assess the skin. Behavior change and irritability suggest hypoglycemia. The nurse could also do a finger stick and check the glucose level. If the client is hypoglycemic, the client will have pale, cold, clammy skin and will need treatment (ingestion of a rapid-acting carbohydrate) at once. An elderly woman has been recently diagnosed as having Type 2 diabetes. Which of the following complaints that she has is most likely to be related to the diagnosis of diabetes mellitus? 1. Pruritus vulvae 2. Cough 3. Eructation 4. Singultus ANSWER 1. Pruritus vulvae (itching of the vulva) frequently accompanies diabetes. Monilial infections are common due to the change in pH. Eructation is belching or burping, and singultus is hiccups. Neither of these is particularly related to diabetes. A client is admitted to the hospital with recently diagnosed Type I diabetes mellitus and is to have fasting blood work drawn this morning. At 7:00 A.M., the lab has not arrived to draw the blood. The client’s dose of regular insulin is scheduled for 7:30 A.M. What is the best action for the nurse to take? 1. Give the insulin as ordered 2. Withhold the insulin until the lab comes and the client will be eating within 15 to 30 minutes 3. Withhold the insulin until the blood has been drawn and the client has eaten 4. Do not administer insulin until the blood work has been drawn and the results have been called back to the unit ANSWER 2. The onset of regular insulin is within 30 minutes. It should not be given until the client can eat within 15 to 30 minutes so that he will not develop hypoglycemia. An elderly client with Type 2 diabetes mellitus develops an ingrown toenail. What is the best action for the nurse to take? 1. Put cotton under the nail and clip the nail straight across 2. Elevate the foot immediately 3. Apply warm, moist soaks 4. Notify the physician ANSWER An ingrown toenail may cause infection, which can be very serious for the diabetic client. The physician should be notified. It is not appropriate for the practical nurse to initiate treatment.