Question

1. A 25-year-old woman has been diagnosed with type 1 diabetes mellitus. She has been placed on a 1500-calorie diabetic diet and is to be started on insulin glargine. Today she has received teaching about her diet, about insulin injections, and about management of diabetes. She received the first dose of insulin glargine at 9 PM; the next morning she complained of feeling "dizzy." The nurse assesses that she is diaphoretic, weak, and pale, with a heart rate of 110 beats/min What is the nurse's priority action at this time? 2. What is the best explanation for these symptoms?

Answer 1

Type I Diabetes mellitus

Diabetes mellitus is a medical disorder characterised by persistent or varying hyperglycemia. In Type I Diabetes mellitus, body produces little or no insulin. Insulin hormone is essential for the body cells to take up the glucose from the blood stream.

Insulin glargine is a long actning insulin, usually prescribed for Type I Diabetes mellitus.

Side effects of Insulin glargine includes injection site reactions, hypoglycemia, hypokalemia( decreased potassium level in the blood)etc.

Nurse's priority actions in hypoglycemia

*Assess the symptoms of hypoglycemia( irritability, dizziness, increased pulse rate, paleness, head ache and sweating)

* let the patient to have simple carbohydrates like glucose tablets, 1 spoon of sugar or honey.

* Monitor the glucose level

Why these symptoms?

Symptoms like diaphoresis, pallor, tachycardia, dizziness and weakness after an administration of insulin injection are due to hypoglycemia. It is common in peoplewith Type I Diabetes mellitus. Timings of insulin injection, less quantity of carbohydrate in the diet, excersise may contribute to hypoglycemia. A considerable reduction in blood glucose level causes the release of adrenaline into blood. This inturn results in increased heart rate, sweating etc. Other hypoglycemic symptoms are dizziness, irritability, weakness headache and pallor.

3. Type 2 Diabetes mellitus

In Type 2 Diabetes mellitus , body doesn't use insulin properly or doesn't produce enough insulin. It is the commonest form of Diabetes.

Corticosteroids are used to treat inflammation especially in case of Asthma, rheumatoid arthritis etc. Corticosteroids may increase the insulin resistance and also causes increase in Blood pressure and glucose level. This inturn results in hyperglycemia, even if the patient is in diabetes controlled diet.

Nurse can educate the client about the importance of corticosteroid therapy and also its side effects,specially diabetic related. Nurse can also assure the patient that ones her treatment ( corticosteroids and antibiotics) is over, her blood sugar level will stabilize.