Diabetes Case Study
Doug is 60-year-old Hispanic male admitted to yourmedical unit with an ulceration on his right foot. His bloodglucose level is 473 and his HgbA1c is 9.5%. His medical historyincludes obesity, HTN, and hyperlipidemia. He was diagnosed withdiabetes mellitus 1 year ago. He tells you that he takes NPH(Humulin R) insulin 20 units every morning and insulin aspart(Novolog) 6 units with each meal. He also takes 10 units of insulinglargine (Lantus) at bedtime.
- What are Doug’s risk factors that may have contributed to hisdiagnosis of DM last year?
- Based on Doug’s lab work findings in the scenario above, doesDoug have good or bad DM management?
- Doug asks what an HgbA1c level is and if his level of 9.5% isgood or bad. How should the nurse respond?
- Doug said his doctor told him to keep his glucose between 100and 150. What is the normal range for blood glucose? Why didn’t thedoctor recommend that Doug keep his glucose in the normalrange?
- If Doug is scheduled to receive his breakfast tray at 0900.Based on the onset of action for these types of insulin, whenshould the nurse administer his NPH and Novolog insulin?
The nurse administers the Novolog insulin to Doug.Within a few minutes of starting to eat breakfast, Doug complainsof nausea and starts vomiting. He is not able to eat any of hisbreakfast. At 1015, Doug complains of dizziness, a headache, andyou noticed he is visibly perspiring.
- Based on this nursing assessment, what do you suspect and whydo you think this happened? How would you confirm yoursuspicions?
- What nursing interventions should you implement based on thissuspicion?
- At 4 pm you check Doug’s glucose level before preparing hisdose of 20 units NPH insulin. The finger stick shows that his bloodglucose is currently 80mg/dL. What do you do?
- Explain the importance of eating regularly scheduled mealsthroughout the day. How would you explain/teach this to Doug?
You did such a good job educating Doug about hisdiabetes last year that after discharge he started exercising,eating nutritious meals, and lost 65 pounds. His HgbA1c leveldropped to 6.4%. Almost 2 years after his last admission, Dougarrives in the ER with a blood glucose level of 41mg/dl.
- What do you think made his glucose level go so low?
Doug mentions that his doctor mentioned that he may beable to stop taking insulin and just be placed on an oral agentsuch as glipizide to help manage his DM.
- Does Doug have type I or type II diabetes? How do youknow?
