A nurse is contributing to the care plan for a client who has recently been diagnosed with type 2 diabetes mellitus. Which of the following interventions should the nurse include in the plan? (Select all that apply.)

Choice A rationale:

Shaking the insulin vial vigorously is not recommended. It can lead to the formation of bubbles, which can affect the accuracy of the dose. Instead, insulin vials should be gently rolled between the hands to mix.

Choice B rationale:

Injecting insulin into the abdominal area is indeed a recommended practice. The abdomen is a preferred site for insulin injection because it has a faster absorption rate compared to other areas. This can help to more effectively regulate blood glucose levels.

Choice C rationale:

Exercise typically lowers blood glucose levels, so insulin doses may need to be reduced to prevent hypoglycemia. Clients should monitor their blood glucose closely and adjust insulin as directed by their healthcare provider.

Choice D rationale:

Freezing unopened insulin vials is not advised. Freezing can disrupt the insulin structure, rendering it ineffective. Insulin should be stored in a refrigerator at a temperature between 2°C and 8°C (36°F and 46°F). Once opened, it can be kept at room temperature for up to 28 days.

Choice A rationale:

Confusion can be a symptom of Diabetic Ketoacidosis (DKA). DKA is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can’t produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated.

Choice B rationale:

Polydipsia, or excessive thirst, is another common symptom of DKA. High blood sugar levels can cause increased urination, leading to dehydration and an increased feeling of thirst.

Choice C rationale:

A rapid pulse is also a symptom of DKA. This is because the body is trying to compensate for the low amount of fluid in your blood vessels due to dehydration.

Choice D rationale:

Clammy skin is not typically a symptom of DKA. It’s more commonly associated with hypoglycemia (low blood sugar), not hyperglycemia (high blood sugar) which is what occurs in DKA1.