Question

You work in the diabetes mellitus (DM) center at a large teaching hospital. The first patient you meet Kat, a 19-year-old Hispanic woman and a college freshman who lives in the honors dormitory, who was just released from the hospital 2 days ago after being diagnosed with type 1 DM.

Nine days ago, Kat went to see the provider after a 1-month history of frequent urination, thirst, severe fatigue, blurred vision, and some burning and tingling in her feet. She attributed those symptoms to working long hours at the computer. Her random glucose level was 410 mg/dL (22.8 mmol/L).

Kat calls the clinic several days later says she has “the flu.” She says she has been nauseated and vomited once during the night. She has had two loose stools. On questioning, she states that she does have a few chills and might have a low-grade fever but does not have a thermometer to check her temperature. She did not check her glucose level this morning or take her insulin because she has “not eaten.”A few days later Kat is found wandering aimlessly about the campus appearing pale and sweaty by one of her friends. He engages Kat in conversation and walks her to the campus medical clinic, where you are on duty. The friend explains how he found Kat and says she was told “diabetic” and takes insulin. Kat is not wearing a medical warning tag. It is 10:20.

A few minutes after administering 2 mg subcutaneous glucagon, Kat begins to awaken. Kat tells you she is on sliding scale lispro (Humalog) four times daily and glargine (Lantus) insulin at bedtime. Her blood sugar was 253 around 09:30, gave herself 6 units of lispro and she was late to class, so she just grabbed an apple on the way.

1. Based on your knowledge of the types of insulin Kat is receiving, when would you expect Kat to experience a hypoglycemic reaction?

2 . List 4 additional points you would stress in a teaching plan with Kat.

Answer 1

Insulin lipro star to act with in 15 minutes and show its peak between 30 to 90 minutes. Kate took insulin at 9.30,so she may experience hypoglycemia between 10 to 11 am.

Kate not taken proper breakfast on that day, so it is important to teach Kate that she should not skip a meal.

She should avoid drinking alcohol including bear and wine because it also cause hypoglycemia.

She should carry a identification badge which may specify she is a diabetic patient. She should also carry last prescription and data of last doctors visit.

Advice her to carry sugar candy with her. It is better to carry glucagon injection, insulin injection with her.