A & P
A hormone that is produced by Beta cells in the pancreas that works to lower blood glucose levels
What is insulin?
Polyuria
Polydipsia
Polyphagia
What are signs of DM?
This is administered usually 30 min before a meal and/or given on a sliding scale.
What is regular insulin?
This drug class decreases the production of glucose in the liver, decreases the absorption of glucose in the liver, and increases the insulin sensitivity ability of cells.
What are biguanides? (Metformin!)
Glucose given via IV push for hypoglycemia
What is IV Dextrose?
This hormone is released by alpha cells when blood glucose levels are reduced.
What is glucagon?
The breakdown of fats and protein for energy
What is ketosis?
The nurse would administer this at bedtime to control glucose levels for the next day
What is long-acting insulin?
This drug class increases the secretion of insulin, decreases gastric emptying of food into the intestines, and decreases glucagon secretion that normally happens post-meal.
What are GLP-1 Agonists?
The activation of this will cause a drop in insulin release and the release of glucose into circulation
What is the sympathetic nervous system (SNS)?
A 62-year-old client with type 2 diabetes asks why their blood glucose remains high despite taking oral medications. The nurse explains that in T2DM, hyperglycemia primarily results from this pathophysiologic process in the pancreas and peripheral tissues, which is also responsible for insulin resistance and progressive beta-cell dysfunction.
What is impaired insulin secretion by pancreatic beta cells and decreased insulin sensitivity in muscle, liver, and adipose tissue?
Uncontrolled or poorly managed BG levels can result in this outcome.
What is reduced perfusion/blood flow?
This insulin category is given 30 minutes before meals.
What is short-acting insulin?
This type of BP medication may make it difficult to recognize hypoglycemia due to a drug interaction.
What are Beta-Blockers?
A 24-year-old client with type 1 diabetes is learning to adjust rapid-acting insulin based on carbohydrate intake. The client’s insulin-to-carb ratio is 1 unit per 12 grams of carbohydrate.
For lunch, the client plans to eat:
2 slices whole-grain bread (30 g carbs)
1 medium apple (25 g carbs)
1 cup milk (12 g carbs)
The client asks the nurse, “How much insulin should I give?”
The nurse recognizes that accurate calculation is critical to prevent this serious complication if the dose is too high or too low.
What is administer 6 units of rapid-acting insulin (67 g total carbs ÷ 12 g/unit) and monitor for hypoglycemia?
A 59-year-old client with newly diagnosed type 2 diabetes presents to the clinic with:
Fasting blood glucose 210 mg/dL
HbA1c 9.2%
Reports fatigue, polyuria, and mild polydipsia
BMI 32 kg/m²
The nurse recalls that in type 2 diabetes, persistent hyperglycemia is caused by both insulin resistance in peripheral tissues and impaired insulin secretion by pancreatic beta cells.
Using this understanding of the underlying physiology, the highest-priority first-line intervention the nurse should focus on is this.
What is initiate lifestyle modifications (diet, exercise, and weight management) to improve insulin sensitivity and reduce glucose levels?
A 60-year-old pt with T2DM food diary:
Breakfast: 2 eggs fried in butter, 2 slices whole-wheat toast, orange juice
Lunch: Cheeseburger with fries, soda
Dinner: Grilled chicken breast, mashed potatoes, corn, sweetened iced tea
The client asks which part of their diet they should focus on first to improve blood glucose control.
What is reduce refined carbohydrates and sugary beverages?
This insulin regimen consists of regular insulin administered 30 min before meals and detemir administered at bedtime.
What is basal-bolus insulin therapy?
A 68-year-old client with type 2 diabetes and mild cognitive impairment is started on a GLP-1 receptor agonist. During follow-up, the nurse notes:
The client reports early satiety, intermittent nausea, and occasional vomiting after meals
Meals often take longer than usual to finish
Swallowing is slow, and the client sometimes coughs when drinking liquids
The nurse recognizes that the delayed gastric emptying caused by the GLP-1 agonist places this client at highest-priority safety risk, requiring immediate monitoring and intervention.
What is aspiration of gastric contents, which can lead to aspiration pneumonia?
A 16-year-old with type 1 diabetes reports feeling sick with a mild fever and headache. Blood glucose readings are 250–300 mg/dL at home. The client asks if they should skip their usual insulin because they are not eating much.
What is continue taking insulin even if sick and monitor blood glucose and ketones?
A 64-year-old client with long-standing type 2 diabetes presents for a routine visit. Assessment reveals:
HbA1c 10.2%
Diminished vibratory and monofilament sensation bilaterally
An intact 1.5 cm plantar callus over the first metatarsal head of R foot
Right foot is cool to touch
Dorsalis pedis pulse 1+ bilaterally
Capillary refill 5 seconds to right foot
The client reports trimming calluses at home with a razor blade
The nurse recognizes that the greatest immediate threat to limb viability is _____.
What is a developing pressure-related diabetic foot ulcer beneath the callus due to loss of protective sensation?
A 72-year-old client with T2DM takes metformin 1000 mg BID. She undergoes a CT scan w/ contrast.
Pre-procedure labs:
Creatinine 1.3 mg/dL
eGFR 46 mL/min/1.73m²
Forty-eight hours post-procedure:
Creatinine 1.5 mg/dL
eGFR 38 mL/min/1.73m²
Urine output adequate
Lactate WNL
pH 7.38
This is the most appropriate nursing action.
What is continue to hold metformin and notify the provider because the eGFR is below 45 and trending downward?
A client receiving IV insulin infusion for severe hyperglycemia develops:
HR 128
BP 92/58
New ECG: prolonged QT interval with U waves
Serum potassium decreased from 4.8 to 2.9 mEq/L in 4 hours
This immediate nursing action is required to prevent deterioration into pulseless ventricular tachycardia.
What is slow or temporarily pause the insulin infusion?
A client taking metformin is admitted with:
pH 7.19
HCO₃⁻ 14 mEq/L
Lactate 6.8 mmol/L (ref:0.5 – 1.5 mmol/L)
Creatinine 3.2 mg/dL (ref: 0.6 - 1.2)
The nurse recognizes that the patient is most likely experiencing what adverse effect?
What is lactic acidosis?
A client presents with
Glucose 620 mg/dL
pH 7.18
HCO₃ 12
Potassium 2.9 mEq/L
The provider prescribes an IV insulin infusion.
This is the nurse’s priority action before initiating insulin therapy.
What is administer IV potassium replacement before starting insulin?