Insulin Basics
Which insulin has no peak and lasts 24 hours?
Long-acting insulin (e.g., glargine); provides basal control with minimal hypoglycemia risk.
What causes fruity breath odor in DKA?
Accumulation of acetone from fat breakdown during ketone production.
What IV fluid is started first in DKA and why?
0.9% NS to restore intravascular volume and perfusion.
Should a patient take insulin while sick if they are not eating?
Yes — illness increases BG; continue insulin and monitor every 2–4 hours.
What is the A1C goal for most diabetic patients?
≤6.5% (or individualized based on comorbidities).
Why must rapid-acting insulin be given within 15 minutes of eating?
It starts working in ~15 min; if no food, hypoglycemia occurs before glucose enters the bloodstream.
List 3 classic symptoms that suggest DKA.
Polyuria, polydipsia, and polyphagia (the “3 P’s”) plus dehydration and Kussmaul respirations.
When and why is dextrose added to IV fluids during DKA treatment?
When BG reaches ~250 mg/dL to prevent rapid glucose drop and cerebral edema.
What are 3 key sick-day rules for Type I DM patients?
Monitor BG q2–4h and check urine ketones if BG >240.
Sip 8–12 oz fluids hourly.
Call provider if vomiting >6h, unable to eat >24h, or BG >300 twice.
Which organ systems are most affected by chronic hyperglycemia?
Eyes, kidneys, nerves, heart, and blood vessels (micro- and macrovascular damage).
A nurse mixes NPH and regular insulin. Which insulin is drawn first, and why?
Draw up regular (clear) before NPH (cloudy) to prevent contaminating the regular vial and altering absorption.
Which lab findings confirm DKA?
BG >250 mg/dL, pH <7.3, HCO₃ <16, positive ketones in blood and urine.
Why must potassium levels be closely monitored during DKA treatment?
Insulin shifts K⁺ into cells → hypokalemia; replacement is needed once K⁺ <3.3 before giving insulin.
Why is patient education on hydration so important during illness?
Dehydration worsens hyperglycemia and can trigger DKA.
What are 2 early signs of diabetic neuropathy?
Tingling or numbness in hands/feet and decreased sensation.
During what phase of insulin therapy is hypoglycemia most likely, and what should the nurse monitor?
During the peak; monitor for tremors, diaphoresis, confusion, tachycardia, and provide 15g carbs if needed.
What is the most common cause of DKA in diabetic patients?
Infection or illness (increased stress hormones → higher BG) or missed insulin doses.
Why should insulin therapy in DKA reduce BG gradually?
Rapid drops cause osmotic shifts → cerebral edema or neuro changes.
What education should be given about monitoring ketones?
Check urine ketones every 3–4h when BG >240 or during illness; positive ketones indicate insulin deficiency.
What patient teaching can help prevent diabetic foot ulcers?
Inspect feet daily, wear supportive shoes, avoid barefoot walking, and report wounds early.
Explain the Somogyi effect vs. Dawn phenomenon and nursing interventions for each.
Somogyi: Nighttime hypoglycemia → rebound hyperglycemia; treat by reducing night insulin or giving a bedtime snack.
Dawn: Early morning hormone surge → high AM glucose; treat with nighttime NPH or increasing bedtime insulin.
Why does DKA cause Kussmaul respirations?
The body tries to compensate for metabolic acidosis by blowing off CO₂ to raise pH.
What is the priority nursing action before initiating insulin therapy in DKA?
Confirm serum potassium is >3.3 mEq/L; otherwise insulin will worsen hypokalemia and cause arrhythmias.
What are two signs that a patient should seek immediate medical help during sick days?
Persistent vomiting, inability to keep fluids down, or BG >300 mg/dL twice with moderate-to-high ketones.
Why is insulin pump use beneficial for some Type I DM patients?
Provides continuous basal insulin, improves control, and reduces hypoglycemia risk through programmable delivery.