Diabetes Mellitus Q 50

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Mr. Wesley is newly diagnosed with Type I DM and is being seen by the home health nurse. The doctor’s orders include: 1200 calorie ADA diet, 15 units NPH insulin before breakfast, and check blood sugar QID. When the nurse visits the patient at 5 pm, the nurse observes the man performing blood sugar analysis. The result is 50 mg/dL. The nurse would expect the patient to be:

  

    A. Anxiety, paleness, and pulse of 110 bpm

    B. Lethargic with hot dry skin and rapid deep respirations

    C. Alert and cooperative with BP of 130/80 mm Hg and respirations of 12 breaths per minute

    D. Short of breath, with distended neck veins and bounding pulse of 96 bpm

    

    

Correct Answer: A. Anxiety, paleness, and pulse of 110 bpm

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Hypoglycemia triggers the release of epinephrine (adrenaline), the “fight-or-flight” hormone which can cause symptoms such as confusion, paleness, and tachycardia. NPH insulin has a somewhat higher risk of hypoglycemia. Inadequate resuspension is thought to contribute to the high day-to-day variability in the pharmacodynamic and pharmacokinetic profile of NPH insulin, leading to hypoglycemia.

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Option B: On examination, vital signs typically reveal tachycardia and tachypnea. Due to the possibility of an infectious trigger for DKA, the patient may be febrile or hypothermic. Kussmaul’s breathing, which is labored, deep, and tachypneic, may occur. Some providers may appreciate a fruity scent to the patient’s breath, indicative of the presence of acetone.

Option C: These are normal vital signs. Neurogenic symptoms and signs arise from sympathoadrenal involvement (either norepinephrine or acetylcholine release) in response to perceived hypoglycemia.

Option D: The clinical manifestations of hypoglycemia can be classified as either neuroglycopenic or neurogenic. Neuroglycopenic signs and symptoms are signs and symptoms that result from direct central nervous system (CNS) deprivation of glucose. These include behavioral changes, confusion, fatigue, seizure, coma, and potential death if not immediately corrected. Neurogenic signs and symptoms can either be adrenergic (tremor, palpitations, anxiety) or cholinergic (hunger, diaphoresis, paresthesias).

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