Question

After running in a half marathon, F.W., a 24-year-old woman with type I diabetes, was brought to the first aid tent provided for participants in a charity run. She is well maintained on a regimen of self-monitoring of blood glucose, insulin, and diet. 

• Subjective Data:

• States that she feels cold and has a headache; her fingers feel numb

• She took her usual insulin dose this morning but was unable to eat her entire breakfast because of lack of time

• Completed the half marathon in a personal-best time

• Objective Data:

• Has slurred speech and unsteady gait

• HR: 120BPM

• Appears confused

• Capillary blood glucose level: 48 mg/dL (2.7 mmol/L)

Discussion Questions:

1. Describe what F.W. could have done to prevent this hypoglycemic event.

2. What is the etiology of manifestations that the patient displays?

3. How would you expect to treat F.W.’s hypoglycemia?

4. Priority Decision: What are the priority teaching needs for this patient once her condition is stabilized?

5. What adjustments in her diabetic regimen could F.W. make to allow her to continue with her exercise habits?

6. Priority Decision: based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?

Answer 1

1. Eating better is the best way to prevent hypoglycemia. It is advised to eat a healthy breakfast 3 hours before the marathon. Also take some source of carbohydrates 1 hour brfore the marathon.

At breakfast, always focus on carbohydrate and protein rich foods. But limit the amount of fat intake. Oatmeal is a good option which is also rich in fibre. Hydrate the body well.

Try to eat a slightly more sugar like a chocolate bar before starting of the marathon to prevent hypoglycemia.

Reduce the dosage of bolus insulin. Because activity can add to the effect of insulin.

2. The eitiology of the manifestation that the patient displayed is because, the body uses sugar and free fatty acids during marathon or exercise. The sugar comes from blood and muscles which is stored as glycogen. To replace the glycogen stores the body takes almost 6 hours. On top of this insulin also causes a reduction in the level of blood glucose level. By this time the patient would have gone to a state of hypoglycemia.  

3. Immediate treatment is required

Check the blood glucose level

If the blood glucose level is less than 70mg/dl, immediately give the patient 20 grams of carbohydrate. This can be a 1/2 cup juice of any fruit or a tablespoon of sugar or a hard candy.

Check the sugar level after 15 minutes

If it is still low repeat the process once again till the patient's blood glucose level becomes normal.

4. The priority teachings for the patient would be regarding the prevention of hypoglycemia and the quick management to be done during hypoglycemia. Teach the patient to carry some hard candies in the pocket for safety precaution. Teach her reagrding the type of foods she needs to take before a marathon or exercise and when to eat the food. Advice the client never to skip the meals when taking insulin and explain to her the importance of it.