Exemplar 12.1: Diabetes

What are a couple of the major differences and similarities between type 1 and type 2 diabetes mellitus?

You are talking to a mother whose 6-year-old daughter has just been diagnosed with type 1 diabetes. She has at least a high school education, but you assess that her medical literacy is low. After speaking with her about her daughter's disorder, you are concerned that she is susceptible to not complying with the treatment regimen, and instead trying naturopathic treatments to "cure" her daughter. Which of the following statements made by the mother would make you think that?

Match the correct signs/symptoms and lab findings with the correct hyperglycemic state. Only place the answers specific to that hyperglycemic state; if the answer is correct for both states, it does not count. Just to make sure nobody has the answer wrong even though it should be right, I've put the answers in ALPHABETICAL ORDER. Diabetic ketoacidosis: -[blank_start]Blood glucose >300 mg/dL[blank_end] -[blank_start]Blurred vision[blank_end] -[blank_start]Confusion[blank_end] -[blank_start]Fruity breath[blank_end] -[blank_start]Increased plasma & urine ketones[blank_end] -[blank_start]Moderate fluid loss[blank_end] -[blank_start]Plasma pH <7.3[blank_end] Hyperosmolar hyperglycemic state: -[blank_start]Blood glucose >600 mg/dL[blank_end] -[blank_start]Extreme thirst[blank_end] -[blank_start]Lethargy[blank_end] -[blank_start]Malaise[blank_end] -[blank_start]Normal breath[blank_end] -[blank_start]Normal plasma & urine ketones[blank_end] -[blank_start]Normal plasma pH[blank_end] -[blank_start]Normal respirations[blank_end] -[blank_start]Profound fluid loss[blank_end] -[blank_start]Seizures[blank_end]

Select the signs and symptoms of hypoglycemia.

You have a 6-year-old boy (J.C.) brought to your emergency room via ambulance after his father (A.C.) called 911. A.C. states that he was about to drive J.C. to urgent care because he was "acting weird" when J.C. suddenly became unresponsive. When asked by the R.N. to specify "acting weird", A.C. states that J.C. could not remember his age, birthday, or location. Prior to passing out, J.C. had been sick at home for about a day with what A.C. called a "stomach flu": he was nauseated, vomiting, had a fever, and had abdominal pain. He was very thirsty, but not diaphoretic. Temp is 101.2 degrees Fahrenheit; BP 85/50; HR 134 bpm; respirations 32/min, labored, regular, even, and symmetrical; SpO2 91%. J.C. is not conscious. Skin is flushed, warm, and dry. Breath smells like fruit. Telemetry shows flat, inverted T waves. Serum potassium is 2.5 mEq/L; serum sodium is 124 mEq/L; serum chloride is 90 mEq/L.. Blood glucose is 375 mg/dL. ABG results shows that pH is 7.29, HCO2 is 18 mEq/L, PaCO2 is 36 mmHg. What acute manifestation of diabetes is J.C. suffering from?

Select appropriate interventions to enact for a patient that is conscious and suffering from diabetic ketoacidosis. Assume that this patient is suffering from severe textbook DKA, with blood pH above 7.20 but below 7.35, hypokalemia, and hyponatremia.

You have a 40-year-old single mother (C.D.) being brought into your ER via ambulance, reportedly because her 12-year-daughter (O.M.) called 911 stating that her mother was "acting weird". Temp is 99.7; BP is 100/62; HR is 120 bpm; respirations are 16/min, regular, even, unlabored, and symmetrical; SpO2 is 96%. C.D. is conscious, but lethargic. She reports dull, throbbing pain, 7/10, generalized throughout abdomen that is worst right before vomiting and better (1/10) for "about 30 minutes" after. Skin is flushed, dry warm, diaphoresis not noted. She reports that she has been running a fever around 102 degrees Fahrenheit, accompanied by nausea and vomiting, for the past 3-4 days. She further reports that she has been very thirsty and has been peeing a lot for "about 2 weeks". Her blood glucose is 720 mg/dL. Sodium is 123 mEq/L, potassium is 2.0 mEq/L, chloride is 91 mEq/L. Telemetry shows inverted T waves. Her ABGs are pH 7.40, HCO3 26 mEqL, and PaCO2 39 mmHg. What acute complication of diabetes is this patient experiencing?

You have a 30-year-old male (M.H.) brought to your ER from the grocery store because, according to a police officer (J.V.), he was allegedly "verbally abusing the customers, employees, and managers". J.V. and his partner were called to detained M.H.. but after noticing a medical alert bracelet stating that M.H. is type 1 diabetic, J.V. opted to call an ambulance instead. Temp is 98.8 degrees Fahrenheit; BP is 98/58; HR is 125 BPM; respirations are 24 breaths/min; SpO2 is 95%. Headache 5/10 reported; M.H. cannot recall when it started, but states there are no alleviating factors. M.H. is still combative; he appears anxious, and cannot recall when be last took his insulin. His skin is pallid, moist, and cool, and he is sweating profusely. He is not thirsty, but informs the RN that he is very hungry. His ABGs are pH 7.38, HCO3 25 mEq/L, PaCO2 40 mmHg. His sodium is 132 mEq/L, potassium is 4.1 mEq/L, and his chloride is 101 mEq/L. Serum osmolality is 290 mOsm/L. Even without being given the blood glucose value, what acute complication of diabetes do you think this patient is experiencing?

You are a high school nurse. Following a very public incident in which a type 1 diabetic student was denied the ability to replenish her blood glucose with a food or drink, you are giving a talk to the teachers about how to manage type 1 diabetes. Which of the following statements about type 1 diabetes is accurate?

Treatment for hyperosmolar hyperglycemic state is similar to the treatment for diabetic ketoacidosis.

You have a 55-year-old male patient that is at risk for developing type 2 diabetes. When you bring it up to him at his yearly physical, he responds with "So what? It just means I'll have to inject myself with insulin. I'll survive." You assess that he might not know the long term effects of diabetes, and asks him if he knows all the problems diabetics face in the long run. He said no, but he seems open to teaching. Select the accurate statements that you can give this patient about the long term-effects of diabetes.

Select the lab values that would strongly warrant a diabetes mellitus diagnosis.

You are teaching a patient newly diagnosed patient with type 2 diabetes about how to test blood glucose. Which of the following statements made by the patient indicates that proper teaching has been received?

Select the correct option from the drop down menu for each type of insulin. -[blank_start]Aspart (NovoLog)[blank_end]: Onset- 15 min; peak- 40-50 min; duration- 3-5 hrs. -[blank_start]Detemir (Levemir)[blank_end]: Onset- 1 hr; peak- 6-23 hrs; duration- 24+ hrs. -[blank_start]Glargine (Lantus)[blank_end]: Onset- 2 hrs; peak- 16-20 hrs; duration- 24+ hrs -[blank_start]Glulisine (Apidra)[blank_end]: Onset- 15 min; peak- 1-1.5 hrs; duration- 3-5 hrs. -[blank_start]Humalog 50/50[blank_end]: Onset- 30 min; peak- 3 hrs; duration; 6-12 hrs. -[blank_start]Humalog 75/25[blank_end]: Onset- 15 min; peak- 2-4 hrs; duration- 6-12 hrs. -[blank_start]Humulin 70/30[blank_end]: Onset- 30 min; peak- 4-8 hrs; duration- 24 hrs. -[blank_start]Lispro (Humalog)[blank_end]: Onset- 15 min; peak- 1-1.5 hrs; duration- 3-4 hrs. -[blank_start]Novolin 70/30[blank_end]: Onset- 30 min; peak- 4-8 hrs; duration- 24 hrs. -[blank_start]NovoLog 70/30[blank_end]: Onset- 25 min; peak- 1-4 hrs; duration- 12-24 hrs. -[blank_start]NPH (Novolin N)[blank_end]: Onset- 2 hrs; peak- 6-8 hrs; duration- 12-16 hrs. -[blank_start]Regular (Novolin R)[blank_end]: Onset- 30 min-1 hr; peak- 2-3 hrs; duration- 4-6 hrs.

The only insulin that can be given IV is a rapid-acting glucose, such as Humalog.

Which insulin cannot be mixed with other insulins and cannot be used in insulin pumps?

Select the rapid acting insulins.

Select the short acting insulins.

Select the intermediate acting insulins.

Select the long acting insulins.

Regular or rapid-acting insulins are the ones used in insulin pumps.

You are teaching a young adult newly diagnosed with type 1 diabetes how to store and properly inject her insulin. She is on Regular insulin. Which of the following statements is incorrect teaching to give to the patient?

You are teaching a 65-year-old female newly diagnosed with type 2 diabetes how to control her diabetes without having to receive daily insulin. You mention oral hypoglycemic agents and dietary control. Which of the following statements made by the patient indicates that more teaching about these topics is needed?