Doug is 47 year old man admitted to your medical unit with an ulceration on his right foot. His blood glucose level is 473. He tells you that he takes NPH (Humulin R) insulin 40 units every morning and Regular (Humulin R) insulin with each meal and at bedtime.
1) Doug said his doctor told him to keep his glucose between 100 and 150. What is the normal range for blood glucose? Why didn’t the doctor recommend that Doug keep his glucose in the normal range?
2) Doug’s first dose of insulin each day is given at 6am. Chart the action of his insulin throughout the day, showing where the insulin was given and where it peaks.
3) When you enter his room to check his 4 p.m. vital signs, he complains of a headache, and he’s started sweating before you finish taking his vitals. Based on your nursing assessment, what do you suspect? How would you confirm your suspicions?
4) What nursing interventions should you implement?
5) Why do you think this incident occured at 4pm?
6) At 5 p.m. you check Doug’s glucose level before preparing his next dose of insulin. The finger stick shows that his blood glucose is currently 80mg/dL. What do you do?
7) Identify 2 possible reasons that Doug’s blood glucose dropped lower than usual.
8) Explain the importance of eating regularly scheduled meals throughout the day. How would you explain/teach this to Doug?
9) You did such a good job educating Doug about his diabetes last year that after discharge he started exercising, eating nutritious meals, and lost 65 pounds. But almost 2 years after his last admission, he arrives in the ER with a blood glucose of 41. What made his glucose level go so low?
10) Doug’s doctor switches him from insulin to glipizide (Glucotrol) 5 mg bid. What are the 2 mechanisms of action for this medication?
11) How often and at what times should Doug take his gucotrol every day?
13) Does Doug have type I or type II diabetes? How do you know?