The patient received Humalog (rapid acting) insulin 5 units subcutaneously at 8:00 AM. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action?

Choice A reason: Metabolic acidosis is a condition where the blood pH is lower than normal, due to an excess of acids or a loss of bases in the body. Jo is most at risk of developing metabolic acidosis, because of the high blood glucose level. High blood glucose can cause diabetic ketoacidosis, a complication of Type 1 Diabetes, where the body breaks down fat for energy and produces ketones, which are acidic substances. Ketones can accumulate in the blood and lower the pH, causing symptoms such as nausea, vomiting, abdominal pain, fruity breath, and confusion.

Choice B reason: Metabolic alkalosis is a condition where the blood pH is higher than normal, due to an excess of bases or a loss of acids in the body. Jo is not likely to develop metabolic alkalosis, because of the high blood glucose level. Metabolic alkalosis can be caused by conditions such as vomiting, diuretic use, or excessive antacid intake, which can increase the bicarbonate level or decrease the chloride level in the blood. These conditions are not related to Jo's diabetes.

Choice C reason: Respiratory acidosis is a condition where the blood pH is lower than normal, due to an accumulation of carbon dioxide in the body. Jo is not prone to developing respiratory acidosis, because of the high blood glucose level. Respiratory acidosis can be caused by conditions that impair the lung function, such as asthma, chronic obstructive pulmonary disease (COPD), or pneumonia, which can reduce the ventilation and increase the carbon dioxide level in the blood. These conditions are not related to Jo's diabetes.

Choice D reason: Respiratory alkalosis is a condition where the blood pH is higher than normal, due to a loss of carbon dioxide in the body. Jo is not susceptible to developing respiratory alkalosis, because of the high blood glucose level. Respiratory alkalosis can be caused by conditions that increase the breathing rate, such as anxiety, fever, or hyperventilation, which can reduce the carbon dioxide level in the blood. These conditions are not related to Jo's diabetes.

Choice A reason: Last eye examination was 18 months ago is not a finding that requires immediate attention from the health care provider. However, the nurse should remind the patient of the importance of regular eye examinations, as diabetes can increase the risk of eye problems, such as cataracts, glaucoma, and diabetic retinopathy. The American Diabetes Association (ADA) recommends that patients with type 2 diabetes have a comprehensive eye examination at least once every two years¹.

Choice B reason: Patient states they are scheduled for a CT scan with contrast dye the next day is a finding that should be promptly discussed with the health care provider. Metformin is a medication that lowers the blood glucose level by reducing the liver's production of glucose and increasing the cells' sensitivity to insulin. Metformin can interact with contrast dye, which is a substance that is injected into the veins to enhance the visibility of organs and tissues in imaging tests, such as CT scans. Contrast dye can impair the kidney function and increase the risk of lactic acidosis, a rare but serious condition where the blood becomes too acidic due to the accumulation of lactic acid. Lactic acidosis can cause symptoms such as nausea, vomiting, abdominal pain, muscle weakness, and breathing difficulties. To prevent this complication, the ADA recommends that patients stop taking metformin at the time of or before the imaging procedure, and resume it 48 hours after the procedure, only if the kidney function is normal².

Choice C reason: Hemoglobin A1C level is 7.9% is not a finding that needs urgent discussion with the health care provider. Hemoglobin A1C is a test that measures the average blood glucose level over the past two to three months. It reflects how well the diabetes is controlled over time. The ADA recommends that most patients with type 2 diabetes aim for a hemoglobin A1C level of less than 7%, as this can reduce the risk of diabetes complications, such as heart disease, kidney disease, nerve damage, and eye damage. A hemoglobin A1C level of 7.9% indicates that the patient's blood glucose level is slightly above the target range, and may need some adjustment in the medication, diet, or exercise plan. However, this is not an emergency situation, and the nurse can review the patient's self-monitoring records, medication adherence, and lifestyle factors, and provide education and support as needed.

Choice D reason: Patient has questions about the prescribed diet is not a finding that warrants immediate communication with the health care provider. However, the nurse should address the patient's questions and concerns, and provide clear and consistent information about the dietary recommendations for type 2 diabetes. A healthy diet for type 2 diabetes should include a variety of foods, such as vegetables, fruits, whole grains, lean proteins, low-fat dairy, and healthy fats. The patient should also limit the intake of added sugars, refined carbohydrates, saturated fats, trans fats, and sodium. The nurse can help the patient plan their meals and snacks, and use tools such as carbohydrate counting, portion control, or the plate method to balance their food choices and blood glucose levels..