Diabetes Mellitus Q 5 - Gyan Darpan : Learning Portal
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Saturday, 9 April 2022

Diabetes Mellitus Q 5

A nurse went to a patient’s room to do routine vital signs monitoring and found out that the patient’s bedtime snack was not eaten. This should alert the nurse to check and assess for:
    A. Elevated serum bicarbonate and decreased blood pH
    B. Signs of hypoglycemia earlier than expected
    C. Symptoms of hyperglycemia during the peak time of NPH insulin
    D. Sugar in the urine

Correct answer: B. Signs of hypoglycemia earlier than expected.

Eating a bedtime snack can prevent blood glucose levels from dropping very low during the night and lessen the Somogyi effect where glucose levels drop significantly between 2:00 a.m. and 3:00 a.m. The Somogyi phenomenon has been a proposed phenomenon in insulin-dependent diabetic patients. The thinking is that these patients should monitor their blood glucose levels and adjust insulin dosages as necessary to prevent hypo- or hyperglycemic episodes.

Option A: Normal human physiological pH is 7.35 to 7.45. A decrease in pH below this range is acidosis, an increase over this range is alkalosis. Metabolic alkalosis is defined as a disease state where the body’s pH is elevated to greater than 7.45 secondary to some metabolic process.
Option C: For many years, the most common insulin used to provide a basal insulin supply has been NPH insulin, but this intermediate-acting insulin often results in nocturnal hypoglycemia due to unwanted plasma insulin peaks, particularly during the night, as well as higher fasting glucose levels.
Option D: Glucosuria connotes the presence of glucose in the urine and is the most frequent type of glycosuria and is the focus of this review. It happens when the glomerulus filters more glucose than the proximal tubule can reabsorb.

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