Glucose Homeostasis and

Regulation

CARE OF THE PATIENT WITH DIABETES MELLITUS

Normal Insulin Metabolism
 Critically Thinking
Like A Nurse
Which laboratory results would indicate that
the patient has prediabetes?
1. Glucose tolerance results of 132 mg/dL
2. Glucose tolerance results of 240 mg/dL
3. Fasting blood glucose result of 80 mg/dL
4. Fasting blood glucose result of 120 mg/dL
 Gerontologic
Considerations
Monitoring Blood Glucose
 Insulin Pump:
Tight Glucose Control
Prediabetes
Type 2 Diabetes
Insulin Resistance
Population at Risk
Oral Hypoglycemic Agents
 Critically Thinking
Like a Nurse
A nurse is caring for a client who has a prescription
for metformin (Glucophage). The nurse should
monitor the client for which of the following
adverse effects?
a) Lactic acidosis
b) Hypoglycemia
c) Hyperlipidemia
d) Respiratory acidosis
Insulin Release
 Insulin
Classificatio Onset Peak Duration
n
Lispro insulin
Rapid-acting (Humalog) 10-30 mins 30 min-3 hr 3-5 hr

Regular insulin
Short-acting (Humulin R) 0.5-1 hr 2-5 hr 5-8 hr

Intermediate- NPH insulin

1.5-4 hr 4-12 hr 16-24 hr
acting (Humulin N)

Insulin glargine
Long-acting 0.8-4 hr none 16-24 hr
(Lantus)
 Administering Insulin
SYRINGE INSULIN PEN
 Critically Thinking
Like a Nurse
A nurse is teaching clients in an outpatient facility
about the use of insulin to treat type 1 diabetes
mellitus. For which of the following types of insulin
should the nurse tell the clients to expect a peak
effect 2 to 3 hr after administration?
a) Insulin glargine (Lantus)
b) NPH insulin (Humulin N)
c) Regular insulin (Humulin R)
d) Insulin lispro (Humalog)
 Critically Thinking
Like a Nurse
When talking with a patient about self-
administering regular insulin (Humulin R), you
should include which of the following
instructions?
a. Shake the vial vigorously
b. Expect the solution to appear cloudy
c. Store unopened vials at room temperature
d. Inject the insulin subcutaneously
The Clinical Question
 Health Promotion
Education
•Medication

•Exercise

•Nutrition
 Critically Thinking
Like a Nurse
The nurse is teaching the patient with prediabetes ways to
prevent or delay the development of type 2 diabetes. What
information should be included (select all that apply)?
1. Maintain a healthy weight
2. Exercise for 60 minutes each day
3. Have blood pressure checked regularly
4. Assess for visual changes on monthly basis
5. Monitor for polyuria, polyphagia, and polydipsia
Diabetes Complications:
Hypoglycemia
Hypoglycemia Management
 Critically Thinking
Like a Nurse
What is the priority action for the nurse to
take if the patient with type 2 diabetes
complains of blurred vision and irritability?
a. Call the physician
b. Check the patient’s blood glucose level
c. Administer insulin as ordered
d. Assess for other neurologic symptoms
Hyperglycemia
 Critically Thinking Like A
Nurse
The patient with diabetes is brought to the emergency department
by his family members, who say that he is not acting like himself and
he is more tired than usual. Number the nursing actions in the order
of priority for this patient.
a) Establish IV access
b) Check blood glucose
c) Ensure patent airway
d) Begin continuous regular insulin drip
e) Administer 0.9% NaCL solution at 1L/hr
f) Establish time of last food medication (s).
Spectrum of Glucose
 THE CLINICAL QUESTION
•

• WOULD YOU ANTICIPATE: GLUCOSE LEVEL TO GO UP OR GO

DOWN?
• VOMITING & DIARRHEA
• FLU
• ADULT HEALTH EXAMINATION (STRESS OF A TEST)
• INFECTION
• SURGICAL PROCEDURE
• RECOVERING FROM AN ILLNESS
• DRINKING ALCOHOL
• IDENTIFY INTERVENTIONS TO ENSURE THEY ARE EUGLYCEMIC
THROUGHOUT THEIR ILLNESS.
Complications of Diabetes
 Diabetic Foot Care

•Inspection
•Prevention
•Review Table
• 49-21
Neuropathy: Complications

ULCERATION AMPUTATION
Retinopathy
How the world looks
with retinopathy….