Type I & Insulin Therapy
Which type of insulin has no peak and provides 24-hour coverage?
Long-acting insulin (e.g., glargine or detemir); it maintains steady basal control and reduces hypoglycemia risk since it has no pronounced peak.
What causes the fruity breath odor in DKA?
The buildup of acetone — a byproduct of fat breakdown during ketone formation — gives the characteristic fruity odor.
What is the first-line medication for Type II diabetes, and what key precaution applies before contrast dye use?
Metformin (a biguanide) — it should be held 48 hours before and after contrast procedures to prevent lactic acidosis and renal toxicity.
What differentiates HHNS from DKA in terms of ketones and pH?
HHNS has little to no ketone production and a normal pH, while DKA has moderate to large ketones and metabolic acidosis (pH < 7.3).
What are the “3 P’s” of hyperglycemia, and what causes them?
Polyuria, polydipsia, polyphagia — caused by osmotic diuresis from excess glucose in the blood leading to dehydration and cellular glucose starvation.
Why must rapid-acting insulin be given within 15 minutes of eating?
Its onset is about 15 minutes — if given too early or without food, hypoglycemia can occur before glucose from the meal enters the bloodstream.
A patient in DKA has a pH of 7.25 and a potassium level of 6.0 mEq/L. What is the nurse’s priority before starting insulin therapy?
Verify that potassium is monitored and replacement fluids are ready — insulin will drive K⁺ into cells and can cause life-threatening hypokalemia.
Which oral antidiabetic medication class can worsen heart failure and requires monitoring of cardiac function?
Thiazolidinediones (TZDs), such as pioglitazone or rosiglitazone — they cause fluid retention and may exacerbate heart failure.
Which type of diabetes is most associated with HHNS, and what typically precipitates it?
Type II diabetes — commonly triggered by infection, illness, or dehydration, especially in older adults with limited fluid intake or impaired thirst.
What is the “Rule of 15” for treating hypoglycemia?
Give 15g of fast-acting carbs (e.g., juice, glucose tabs), recheck BG in 15 minutes, and repeat if still <70 mg/dL; call provider if no improvement after 2–3 cycles.
A nurse is preparing to mix NPH and regular insulin. Which insulin is drawn up first, and why?
Regular insulin is drawn up first (“clear before cloudy”) to avoid contaminating the regular vial with NPH, which could alter absorption rates.
What IV fluid is started first in DKA, and why is it later switched?
Start with 0.9% normal saline (NS) to restore perfusion; once BP stabilizes, switch to 0.45% NS for cellular hydration, and add 5% dextrose when BG reaches ~250 mg/dL to prevent cerebral edema.
Name one medication class that promotes weight loss and provides cardiovascular protection in Type II DM.
GLP-1 receptor agonists (e.g., liraglutide, semaglutide) or SGLT-2 inhibitors (e.g., empagliflozin, dapagliflozin) — both reduce CV risk and aid in weight loss.
Explain the pathophysiology behind altered level of consciousness in HHNS.
Extreme hyperglycemia (> 600 mg/dL) causes cellular dehydration and serum hyperosmolality (> 340 mOsm/L), leading to neuronal dehydration and brain dysfunction.
What type of dietary pattern helps stabilize glucose levels in Type II DM?
A balanced diet with 45–60% complex carbs, lean proteins (15–20%), and healthy fats (<20%), focusing on whole grains, fiber, and limited simple sugars.
During what phase of insulin administration is the patient most at risk for hypoglycemia, and what should the nurse monitor?
During the peak of insulin action; monitor for sweating, tremors, tachycardia, confusion, and ensure quick access to 15g of carbs.
Why must blood glucose be lowered gradually during DKA treatment?
Rapid correction shifts fluid into brain cells, increasing intracranial pressure and risking cerebral edema — gradual decline prevents neurologic injury.
Why should a patient taking sulfonylureas avoid alcohol?
Alcohol potentiates the hypoglycemic effects of sulfonylureas (like glipizide or glyburide), increasing risk for severe hypoglycemia and disulfiram-like reactions.
List three key laboratory findings expected in HHNS.
Blood glucose > 600 mg/dL
Serum osmolality > 340 mOsm/L
Negative or trace ketones; normal pH and bicarbonate
(Also often ↑ BUN/creatinine due to dehydration)
Provide three key “DO NOT” rules for diabetic foot care.
Do not soak feet or use hot water/pads (risk burns).
Do not walk barefoot or wear tight shoes/socks.
Do not cut calluses or toenails deeply — file straight across, and report wounds promptly.
Explain how the Somogyi effect differs from the Dawn phenomenon, including when they occur and their nursing interventions.
Somogyi: Nighttime hypoglycemia triggers rebound hyperglycemia (2–3 a.m. drop → morning high). Treat by decreasing bedtime insulin or adding a bedtime snack.
Dawn: Early morning (5–8 a.m.) rise from natural hormones (cortisol, GH). Treat by adding or increasing nighttime NPH insulin.
List three nursing interventions to prevent DKA in a sick diabetic patient.
Continue insulin even if not eating.
Monitor BG every 2–4 hours and check urine ketones if BG > 240 mg/dL.
Maintain hydration (8–12 oz/hr) and call the provider if vomiting > 6 hours, unable to eat > 24 hours, or BG > 300 mg/dL twice.
Compare the onset, peak, and duration of rapid-acting insulin versus regular insulin, and identify when each is most appropriate.
Rapid-acting (lispro, aspart): Onset 15 min, peak 1 hr, duration 3 hrs → give with meals.
Regular insulin: Onset 30 min, peak 2 hrs, duration 8 hrs → best for IV use and sliding-scale coverage.
What are two life-threatening complications if HHNS is corrected too quickly?
Cerebral edema (from rapid osmotic fluid shifts) and hypokalemia (from insulin driving K⁺ into cells). Both require slow glucose correction and close electrolyte monitoring.
A patient wants to exercise, but their BG is >250 mg/dL and urine shows ketones. What should the nurse instruct?
Avoid exercise — elevated BG with ketones indicates insulin deficiency; exercise would worsen ketosis and hyperglycemia. Encourage rest and contact the provider.