Question

Mr. Biden has been diagnosed with Type 2 diabetes. He injects 10 units of NPH insulin and 5 units of Regular insulin SQ in the morning and evening before meals. Recently, he has been exercising more and reports several episodes of dizziness, shakiness, and diaphoresis. What problem do his symptoms suggest ? How might the Nurse Practitioner adjust his insulin dose ? Please explain your rationale.

Answer 1

The symptoms of dizziness, shakiness and diaphoresis are sign of hypoglycemia. This is because of the bodies use of glucose in excess by exercise and insulin.

When a patient takes NPH insulin it lasts about 2t hours and regular insulin for about 8 hours and controlling the blood sugar level, but doing a exercise in excess can further deplete the glucise level of the body demanding for glucose and causing the symptoms.

The nurse first has to give general instruction like

• No rigorous long time exercise
• Adjust insulin dose in accordance to basal insulin level ,food habits ,exercise by providing bed time insulin namely NPH instead of giving in the evening

Adjusting the insulin on the basis of basal insulin rate can prevent dawn phenomenon (raise in blood sugar at morning time) and drop in the day time