Question

Marshall, a 25-year-old manual laborer, visits his physician to have the stitches removed from a wound on his right arm. Dr. Geer notes that the incision is not healing well. He also observes that Mr. Marshall seems lethargic, so he decides to do a physical examination and some routine laboratory work.

Mr. Marshall’s history reveals a recent weight loss of 8 pounds, lethargy, polydipsia, and polyuria. His fasting blood glucose is elevated (425 mg/dL) and the urine is positive for ketones. There is a family history of diabetes mellitus. Dr. Geer admits Mr. Marshall to the hospital to control his diabetes. The client is started on 10 units of U-100 regular insulin and 25 units of NPH U-100 insulin before breakfast. A sliding scale of U-100 regular insulin dosage based on the results of the QID blood glucose testing is established. The nurse checks Mr. Marshall’s Accucheck at 7:30AM. The reading was 230mg/dL

<150 0 units

151 – 200 2 units

201 – 250 4 units

251 – 300 6 units

301 – 350 8 units

351 – 400 10 units

In addition to this treatment, Mr. Marshall receives instruction concerning a 2,200-calorie diabetic diet. After several days, his fasting blood glucose is approaching normal value (150 mg/dL). He reports feeling better. A client education program is begun, with individual sessions 4 days a week and group sessions once a week. Mr. Marshall seems to be doing well and can administer his own insulin, but one day, a setback occurs.

At about 4:00 pm he begins to perspire profusely, develops a headache, and experiences a tremor in his hands. In addition, he feels nauseated.

During this hipitalization, Mr. Marshall is started on an intensive insulin therapy regimen with insulin glargine and Hmalog.

1. Explain this regimen in terms of its benefit, dosing schedule, possible adverse effects, and patient teaching

2. Indicate the sites that can be used for insulin injections

3. What would you teach Mr. Marshall regarding insulin administration and site rotation?

Answer 1

Answer: Insulin glargine is a form of insulin which is long a ring and used in the treatment of diabetes. It has importance as it is long acting insulin so it has to be administered once in a day. The adverse effects includes:

• Rashes
• Itching
• Difficulty in breathing

The dose include as it is long acting so it is given once in a day (10 milliliter (ml) vial) sometimes in combination with the oral medicine.

The insulin is injected in the subcutaneous tissue i.e. on the stomach or abdomen, back of the upper arms, the outer side of the thighs as well as upper buttocks.

The insulin administration can be done at any time of the day, but the insulin should not be over dose as it may cause hypoglycemia. The injection can be given on the things also.