An adult patient with type 2 diabetes mellitus (DM2) is due to be admitted to the medical unit from the emergency department within the next hour.
The patient’s lab results show that the serum glucose is 175 mg/dL (9.63 mmol/L) and the A1c is 9%. Which meal option should the nurse request for the patient’s dinner tray?

Choice A rationale
Mixing the dextrose in a 50 mL piggyback for a total volume of 100 mL is not the appropriate method for administering the medication. This would dilute the dextrose, reducing its concentration and potentially making it less effective.
Choice B rationale
Diluting the dextrose in one liter of 0.9% normal saline solution is not the appropriate method for administering the medication. This would significantly dilute the dextrose, reducing its concentration and potentially making it less effective.
Choice C rationale
Requesting the pharmacist to add the dextrose to a total parenteral nutrition (TPN) solution is not the appropriate method for administering the medication. While dextrose is often a component of TPN solutions, in this case, the patient requires a concentrated dose of dextrose to treat insulin shock.

Choice D rationale
This is the correct answer. Administering the undiluted dextrose slowly through the currently infusing IV is the appropriate method for administering the medication. This allows for the rapid administration of a concentrated dose of glucose, which is necessary to quickly raise the patient’s blood glucose level in the case of insulin shock.

Choice A rationale
Administering the medication at 1000, 1600, 2200, and 0400 would not be the best schedule because it does not evenly distribute the doses throughout the day. This could lead to periods of subtherapeutic medication levels and periods of potential toxicity.
Choice B rationale
Administering the medication with meals and a bedtime snack is not the best schedule for this medication. While some medications need to be administered with food, there is no indication

that this medication needs to be. Furthermore, this schedule could lead to uneven distribution of the medication throughout the day.
Choice C rationale
Giving the medication in equally divided doses during waking hours is not the best schedule because it does not take into account the half-life of the medication or the patient’s sleep schedule. This could lead to subtherapeutic levels of the medication during the night.
Choice D rationale
Administering the medication at 0800, 1200, 1600, and 2000 is the best schedule for this medication. It evenly distributes the doses throughout the day, which can help maintain a therapeutic level of the medication and reduce the risk of toxicity.