An 8-year-old boy with type 1 diabetes has been receiving NPH and regular insulin. His mother calls the nurse and explains that the child's morning blood glucose readings have been above 200 mg/dL. What should the nurse advise the mother to do?
1. Raise his NPH dose by two units to cover the elevation in the early morning.
2. Change the time of the night dose to 1 hour before sleep.
3. Do blood glucose checks during the night.
4. Keep a glass of water near the bed to dilute the sugar levels during the night.
Rationale: (3)
The child is having a rapid decrease in his blood glucose level during the night, causing a hyperglycemic rebound response. The rebound rise in the blood sugar reading is picked up in the morning blood glucose reading, which can lead to misinterpretation. This may be classified as a Somogyi effect. (Hockenberry, Wilson, 9 ed., p. 1603.)
Learn More :
Metabolic Concept
- A client is scheduled for a routine glycosylated hemoglobin (HbA1C) test. What is important for the nurse to tell the client before this test?
- What will the nurse teach the client with diabetes regarding exercise in the treatment program?
- A nurse knows the clinical manifestations of a client with Addison's disease include which of the following?
- A client is receiving NPH insulin 20 units subcutaneously at 0700 hours daily. At 1500 hours, the nurse finds the client apparently asleep. How would the nurse know whether the client was having a hypoglycemic reaction?
- What is important to teach a client with adrenal insufficiency who has a prescription for prednisone?
- The nurse is discussing with a child and family the various sites used for insulin injections. The nurse would explain that the following site has the fastest rate of absorption:
- A client with an acute exacerbation of ulcerative colitis has type 2 diabetes that is controlled with diet and metformin (Glucophage). The health care provider orders prednisone to reduce inflammation in the colon. What would the nurse anticipate as part of the client's plan of care?
- A client is learning to inject his own insulin. Which of the following nursing observations would indicate to the nurse that the client needs further teaching?
- A child with newly diagnosed diabetes is in the emergency room and is unconscious. Glucagon has been prescribed for treatment of hypoglycemia. What would be important nursing management?
- A client with type 1 diabetes calls the nurse because of nausea and not feeling well. What would be important for the nurse to tell the client?
- The physician orders hydrocortisone daily for a client with Addison disease. The nurse explains to the client that the dosage may need to be adjusted because of which concern?
- The nurse is teaching the parents of a child who is experiencing difficulty with control of his diabetes. Which of the following agents should the nurse teach the parents to administer if their child loses consciousness and has a severe hypoglycemic reaction?
- If dietary trays are usually brought to the nursing unit at 8:00 am, the nurse should plan to administer intermediate-acting insulin (Humulin N), 40 units, subcutaneously to a client between:
- A client who is planning a trip to the beach is taking glipizide (Glucotrol). What would be important for the nurse to discuss with the client?