A patient with diabetes is starting on insulin therapy. Which type of insulin will the nurse discuss using for mealtime coverage?

Choice A reason: I will need to take medication by mouth until my blood sugar is within normal limits again is an incorrect statement that indicates the need for further teaching. Type 1 diabetes mellitus (DM) is a condition where the pancreas does not produce any insulin, a hormone that helps the cells use glucose for energy. Patients with type 1 DM need to take insulin injections or use an insulin pump for life to replace the missing hormone. Oral medications for diabetes are not effective for type 1 DM, as they work by stimulating the pancreas to produce more insulin or by increasing the sensitivity of the cells to insulin.

Choice B reason: If I get the flu, the dose of my insulin may need to be altered to control my blood glucose is a correct statement that shows understanding of the disease process. Illnesses such as the flu can increase the blood glucose level, as the body releases hormones that counteract the effects of insulin. Patients with type 1 DM may need to adjust their insulin dose, monitor their blood glucose more frequently, and check for ketones in their urine or blood when they are sick. Ketones are acidic substances that are produced when the body breaks down fat for energy, and can lead to a serious complication called diabetic ketoacidosis.

Choice C reason: I will monitor my blood glucose to help determine whether my medication is working as anticipated is another correct statement that demonstrates knowledge of the disease management. Blood glucose monitoring is an essential part of diabetes care, as it helps the patients and the health care providers to evaluate the effectiveness of the insulin therapy, the diet, and the exercise plan. Blood glucose monitoring also helps to prevent or detect hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar), and to adjust the insulin dose accordingly.

Choice D reason: The things that I eat may impact the dose of my medication used to control my blood glucose is also a correct statement that reflects awareness of the disease implications. The amount and type of carbohydrates that the patients eat can affect their blood glucose level, as carbohydrates are the main source of glucose in the diet. Patients with type 1 DM need to balance their insulin dose with their carbohydrate intake, and follow a consistent and healthy eating pattern. They may also use carbohydrate counting, a method of estimating the grams of carbohydrates in the foods they eat, to help them plan their meals and snacks.

Choice A reason: This statement is true. Fluid volume deficit, or hypovolemia, is a condition where the body loses more fluid than it gains. It can be caused by fluid loss from vomiting, diarrhea, bleeding, or excessive sweating. Fluid volume deficit can lead to dehydration, hypotension, tachycardia, and shock.

Choice B reason: This statement is false. Sodium imbalance, or dysnatremia, is a condition where the blood sodium level is either too high or too low. It can be caused by fluid imbalance, kidney disease, hormonal disorders, or medications. Sodium imbalance can affect the brain function, causing confusion, seizures, or coma.

Choice C reason: This statement is false. Potassium imbalance, or dyskalemia, is a condition where the blood potassium level is either too high or too low. It can be caused by kidney disease, acid-base disorders, medications, or dietary intake. Potassium imbalance can affect the heart function, causing arrhythmias, cardiac arrest, or death.

Choice D reason: This statement is false. Fluid volume excess, or hypervolemia, is a condition where the body gains more fluid than it loses. It can be caused by fluid overload, heart failure, kidney failure, or liver disease. Fluid volume excess can lead to edema, hypertension, dyspnea, and pulmonary congestion.