Insulin is not used to control blood glucose in patients with type 2 diabetes.
Complications of type 2 diabetes are less serious than those of type 1 diabetes.
Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma. .
Changes in diet and exercise may be sufficient to control blood glucose levels in type 2 diabetes
Self-monitoring of blood glucose.
Use of low doses of regular insulin.
Lifestyle changes to lower blood glucose.
Effects of oral hypoglycemic medications.
The patient always carries hard candies when engaging in exercise.
The patient goes for a vigorous walk when the glucose is 200 mg/dL.
The patient has a peanut butter sandwich before going for a bicycle ride.
The patient increases daily exercise when ketones are present in the urine.
“Have you lost any weight lately?”
“How long have you felt anorexic?”
“Is your urine unusually dark colored?”
“Do you crave fluids containing sugar?”
Urine dipstick for glucose
Oral glucose tolerance test
Fasting blood glucose level
Glycosylated hemoglobin level
The patient will have a glycosylated hemoglobin level of less than 7%.
The patient will have a diet and exercise plan that results in weight loss.
The patient will choose a diet that distributes calories throughout the day.
The patient will state the reasons for eliminating simple sugars in the diet.
Check glucose level before, during, and after swimming.
Delay eating the noon meal until after the swimming class.
Increase the morning dose of neutral protamine Hagedorn (NPH) insulin.
Time the morning insulin injection so that the peak occurs while swimming.
“I may have an occasional alcoholic drink if I include it in my meal plan.”
“I will need a bedtime snack because I take an evening dose of NPH insulin.”
“I may eat whatever I want, as long as I use enough insulin to cover the calories.”
“I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia.”
Remind the patient that exercise will improve self-esteem.
Determine what type of exercise activities the patient enjoys.
Give the patient a list of activities that are moderate in intensity.
Teach the patient about the effects of exercise on glucose level.
“I need to rotate injection sites among my arms, legs, and abdomen each day.”
“I will buy the 0.5 mL syringes because the line markings will be easier to see.”
“I should draw up the regular insulin first after injecting air into the NPH bottle.”
“I do not need to aspirate the plunger to check for blood before injecting insulin.”
The patient avoids injecting the insulin into the upper abdominal area.
The patient cleans the skin with soap and water before insulin administration.
The patient places the insulin back in the freezer after administering the prescribed insulin dose.
The patient pushes the plunger down and immediately removes the syringe from the injection site.
The patient changes the site for the insertion site every week.
The patient programs the pump to deliver an insulin bolus after eating.
The patient takes the pump off at bedtime and starts it again each morning.
The patient states that diet will be less flexible when using the insulin pump.
NPH (Humulin N)
Glyburide decreases glucagon secretion from the pancreas.
Glyburide stimulates insulin production and release from the pancreas.
Glyburide should be taken even if the morning blood glucose level is low.
Glyburide should not be used for 48 hours after receiving IV contrast media.
“Other medications besides the Glucotrol may affect my blood sugar.”
“If I overeat at a meal, I will still take just the usual dose of medication.”
“When I become ill, I may have to take insulin to control my blood sugar.”
“My diabetes is not as likely to cause complications as if I needed to take insulin.”
Need a diet higher in calories while receiving prednisone.
Require administration of insulin while taking prednisone.
Develop acute hypoglycemia while taking the prednisone.
Have rashes caused by metformin-prednisone interactions.
Save the lunch tray to be provided upon the patient’s return to the unit.
Call the diagnostic testing area and ask that a 5% dextrose IV be started.
Ensure that the patient drinks a glass of milk or orange juice at noon in the diagnostic testing area.
Request that the patient be returned to the unit to eat lunch if testing will not be completed promptly.
Washes the puncture site using soap and warm water.
Chooses a puncture site in the center of the finger pad.
Hangs the arm down for a minute before puncturing the site.
Says the result of 130 mg indicates good blood sugar control.
Ask the patient’s family to participate in the diabetes education program.
Assess the patient’s perception of what it means to have diabetes mellitus.
Demonstrate how to check glucose using capillary blood glucose monitoring.
Discuss the need for the patient to actively participate in diabetes management.
Give 50% dextrose as a bolus.
Insert a large-bore IV catheter.
Initiate oxygen by nasal cannula.
administer glargine (Lantus) insulin.
Use only the lispro insulin until the symptoms of infection are resolved.
Monitor blood glucose every 4 hours and notify the clinic if it continues to rise.
Decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%.
Limit intake of calorie-containing liquids until the glucose is less than 120 mg/dL.
Check the patient’s blood glucose at 3:00 AM.
Administer a larger dose of long-acting insulin.
Educate about the need to increase the rapid-acting insulin dose.
Remind the patient about the need to avoid snacking at bedtime.
Assess the patient for symptoms of hyperglycemia.
Give the patient a snack of crackers and peanut butter.
Have the patient drink a glass of orange juice or nonfat milk.
Administer a continuous infusion of 5% dextrose for 24 hours.
“Have you observed any recent skin changes?”
“Do you notice any bloating feeling after eating?”
“Do you need to increase your insulin dosage when you are stressed?”
“Have you noticed any painful new ulcerations or sores on your feet?”