Question

In: Nursing

LR is a 56-year old female who was diagnosed with Type 2 diabetes mellitus two years ago.

Diabetes Type 2

LR is a 56-year old female who was diagnosed with Type 2 diabetes mellitus two years ago. Her initial treatment consisted of metformin 850 mg twice daily. At her last visit, her Hemoglobin A1C was 9.5%. Her physician is changing her treatment plan to add insulin glargine (Lantus) 20 units once a day.

1. What is the onset, peak, and duration of insulin glargine?

2. List the main teaching points the nurse would include when teaching LR about her new treatment plan.

3. What are the signs & symptoms of hypoglycemia?

In addition to adding insulin to the treatment plan, the physician also orders a blood glucose meter and supplies so LR can test her glucose two to three times a day before meals.

4. What additional teaching should the nurse include regarding the blood glucose monitor?

5. What is the significance of LR’s hemoglobin A1C level?

6. If LR’s hemoglobin A1C does not decrease at her next visit in three months, what additional modifications do you think the physician will make to the treatment plan?

Solutions

Expert Solution

1 . The onset of action of glargine ( Lantus ) is 1.5 to 2 hours. It reaches peak effect in 5 hours and the duration of action lasts for 24 hours. Therefore, glargine is a long acting insulin.

  • 2. The nurse has to teach LR about subcutaneous administration of insulin if this is her first experience with insulin.
  • Teach her about signs and symptoms of hypoglycemia associated with insulin.
  • Inform her to keep sugar based biscuits or sweets always handy in case of symptoms of hypoglycemia.
  • Tell her to be careful at about 5 hours after insulin as it's the peak time of action for few days after the start of insulin.

3 . Signs and symptoms of hypoglycemia :

  • Sweating profusely.
  • Fainting
  • Extreme hunger.
  • Nausea
  • Vomiting.
  • Blurred vision.
  • Tremors
  • Palpations
  • Dry mouth.
  • Slurred speech.

4 . The nurse should teach her about the blood monitoring using the monitor.

Teach when to check sugar levels - early morning before breakfast, after 2 hours of breakfast and when experiencing the signs and symptoms of hypoglycemia.

Teach regarding errors that may occur during the testing.

5 . LR's HbA1c level is 9.5 %. While the normal value is below 6 % which means LR has very poorly managed diabetes.

6 . If LR's HbA1c doesn't decrease, the doctor may alter the dose of insulin and increase the frequency to two times a day along with nutritional modification and physical activity levels.


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