Case Study: Diabetes Mellitus
Sarah Smalley is a 22-year-old college student. Twelve years ago, Sarah began to experience polyphagia, polydipsia, and polyuria and was subsequently diagnosed with Type 1 diabetes mellitus. She was started on an insulin and blood glucose monitoring regimen.
She presents to the clinic for a routine health evaluation.
Results for question 1.
10 / 1 point
Categorisation
As part of your assessment, you ask Sarah about her insulin regimen, her blood glucose readings, and if she is experiencing hypoglycemic or hyperglycemic episodes on those insulin dosages. Sarah’s boyfriend asks about the signs and symptoms of each so he can be aware if Sarah is unwell.
Of the following cues, how would you classify each of these signs and symptoms: hypoglycemia or hyperglycemia?
CategoryHypoglycemia
Correct answer:
headache
Correct answer:
weakness
Correct answer:
pallor
Correct Answer: Hyperglycemia
Correct answer:
clammy
Correct answer:
tachycardia
Correct answer:
sweating
Correct Answer:
increased hunger
CategoryHyperglycemia
Correct answer:
dry mouth
Correct answer:
ketones or glucose in urine
Correct answer:
increased thirst
Correct answer:
dry, flushed skin
Correct answer:
nausea
Correct answer:
increased urination
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General Feedback
Hypoglycemia: headache, pallor, sweating, tachycardia, weakness. clammy
Hyperglycemia: dry mouth, increased thirst, increased hunger, increased urination, nausea, dry, flushed skin, ketones or glucose in urine
Results for question 2.
21 / 1 point
Multiple choice
Sarah’s HbA1C is 6.2%. She asks why she has to have this lab drawn and also check her capillary blood glucose 4-6 times a day. What would be your best response?
“The HbA1C will tell you if you need an immediate insulin adjustment.”
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“The HbA1C will measure your current blood sugar level.”
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Correct answer:
“The HbA1C will assess your average blood glucose control over the past 2-3 months.”
“The HbA1C will monitor for signs of diabetes-related complications.”
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Feedback
General Feedback
The purpose of the HbA1C test is to determine blood glucose levels over a 2-3 month period.
Results for question 3.
31 / 1 point
Multiple choice
Is a HbA1C of 6.2% acceptable for someone with diabetes?
No, this HbA1c is too high. The goal is less than 5.9%.
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Correct answer:
Yes, this HbA1C is acceptable for someone with diabetes mellitus. The goal is less than 6.5%.
Feedback
General Feedback
Research has demonstrated that lowering A1c levels to 6.5% is associated with decreased microvascular complications (eye, kidney, and nerve diseases) of diabetes.
Results for question 4.
41 / 1 point
Multiple choice
You ask Sarah what she would do if she began sweating and felt her heart racing in the middle of class. Which of the following is an acceptable way to treat a hypoglycemic episode?
Eat a snack when she returns back to her apartment.
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Correct answer:
Eat a snack that consists of 15g of carbs followed by a protein.
Self-administer a dose of glucagon via injection.
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Administer 5 units of regular insulin.
, Not Selected
Feedback
General Feedback
Patients should have an emergency plan and supplies for treating low glucose. When signs of hypoglycemia are present and the patient is able to swallow, give one of the following to provide 15 to 20 g of glucose or simple carbohydrates. Follow up with a longer-acting source, such as crackers and cheese or a meat sandwich.
Results for question 5.
51 / 1 point
Multiple answer
The provider evaluates Sarah’s health and reviews her insulin dosing with her. Because her HbA1C is normal, they do not want to make any changes at this time.
Flu season is approaching, and the provider asks you to review sick-day rules with Sarah before she leaves. Which of the following are best practice for sick days? Select all that apply.
Answer,
Test your blood glucose every 8 hours.
Answer,
Eat extra meals to give your body energy to fight a virus or infection.
Answer,
Limit fluid intake so you do not feel nauseated.
Correct answer:
Call the health care provider right away for vomiting, abdominal pain, or a temperature higher than 100.2° F (38.8° C).
Correct answer:
Take insulin as prescribed. Adjust the dosage if necessary based on blood glucose levels.
Feedback
General Feedback
What to Do on Sick Days
A bad cold, flu, or minor gastrointestinal upset can create problems for diabetic patients.
Medication
• Take insulin as prescribed. Adjust the dosage as directed, depending on blood glucose readings.
• If taking an oral hypoglycemic, take usual dose. Do not increase the dose unless ordered to do so by the health care provider. If vomiting and unable to take medication by mouth, the health care provider may temporarily prescribe insulin.
Diet
• Eat a normal diet on schedule.
• If nausea and vomiting occur, replace carbohydrate solid foods in the normal diet with liquids that contain sugar (fruit juice, regular soft drinks, or Jell-O).
• Take at least 1 cup of water or calorie-free, caffeine-free liquid each hour. If nauseated, take small sips to help prevent vomiting.
Monitoring
• Test blood glucose at least every 4 hours and record result. If severely ill, check blood glucose every 2 hours.
• Test urine for ketones if blood sugar level is higher than 300 mg/dL.
Notifying the Health Care Provider
• Call the health care provider right away for vomiting, abdominal pain, or a temperature higher than 100.2° F (38.8° C).
• Notify the health care provider if blood glucose is higher than 200 mg/dL or if urine test shows ketones.
• Report to the health care provider if blood glucose level that was higher than 200 mg/dL does not come down with an additional dose of insulin.
• If unable to reach the health care provider, go to the hospital emergency department.
Results for question 6.
61 / 1 point
Multiple answer
Which of the following are potential complications of poorly controlled blood glucose levels? Select all that apply.
Correct answer:
Nephropathy resulting from poor renal circulation
Correct answer:
Cardiovascular disease including heart attack and stroke
Correct answer:
Neuropathy including paresthesia, numbness, and loss of function
Correct answer:
Retinopathy including visual impairment and blindness
Correct answer:
PVD resulting from poor wound healing and peripheral circulation
Feedback
General Feedback
The alterations in the macrovascular system result in coronary artery disease, peripheral arterial disease, and stroke. Microvascular complications result from damage to the small vessels at the capillary level. This causes diabetic nephropathy, neuropathy, and retinopathy.
Results for question 7.
71 / 1 point
Multiple answer
Which of the following should be part of a nurse’s assessment before administering insulin? Select all that apply.
Correct answer:
Time of the next meal or snack
Correct answer:
A current blood glucose level
Answer,
Last recorded void
Answer,
A determination if the client has Type 1 or Type 2 Diabetes Mellitus
Feedback
General Feedback
When caring for a patient with diabetes, you should know the schedule for meal tray delivery and plan glucose testing and insulin injections for appropriate times. Fingersticks for blood glucose testing should be performed 30 minutes before breakfast. If 1 hour has elapsed without insulin being given after the reading was obtained, the test must be repeated before insulin administration. If rapid-acting insulin is ordered, it should not be given until the food tray is in front of the patient.
Results for question 8.
81 / 1 point
Multiple choice
The nurse is counseling an overweight, noncompliant, 30-year-old female with Type 2 diabetes mellitus. Which change is most important for the nurse to suggest?
Keep a food diary
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Correct answer:
Begin an exercise program and lose weight
Obtain annual eye examinations
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Inspect feet daily
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Feedback
General Feedback
In many cases, people with type 2 diabetes can control their blood glucose by reducing caloric intake and increasing physical exercise.
