Nursing B05: Med/Surg
Case study # 1,
Scenario
Y.L. makes an appointment to come to the clinic where you are employed. She has been complaining of chronic fatigue, increased thirst, constant hunger, and frequent urination. She denies any pin, burning, or low-back pain on urination. She tells you she has a vaginal yeast infection that she has treated numerous times with over-the-counter (OTC) medication. She admits to starting smoking since going back to work full time as a clerk in a loan company. She also complains of having difficulty reading numbers and reports making frequent mistakes. She says, “By the time I get home, and make supper for my family, them put my child to bed, I am too tired to exercise.” She reports her feet
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Identify the three functions of insulin.
* Regulating glucose metabolism *
2. Y.L. was started on Lispro (Humalog) and glargine (Lantus) insulins with carbohydrate counting. What is the most important point to teach the patient about glargine?
Glargine cannot be diluted or mixed with any other insulin or solution.
3. Y.L. was on regular insulin in the past when she was pregnant. As the nurse providing her with insulin teaching you want to ensure she understands the difference between regular and lispro. What is the most significant difference between these two insulins?
The most significant difference between the regular insulin and the rapid acting insulin is the onset. The onset for rapid-acting or lispro is 10-15 minutes, and for the regular it is ½-1 hour.
4. Y.L also used to take NPH when pregnant. She is more familiar with it. Provide and explain two advantages of glargine and lispro over NPH and regular.
5. Y.L’s culture prefers foods high in carbohydrates. What is carbohydrate counting, and why would this method work well for Y.L.?
Carbohydrate counting requires the person to count the carbohydrates in the foods they eat and to set a limit to how much he/she can eat in a day to keep their blood glucose in range. This helps control blood glucose levels because carbohydrates increase glucose levels more than any other food.
7. Which of the symptoms that Y.L. reported today led you to believe she
The importance of tight glycemic control has been shown to prevent and/or delay long-term complications of diabetes.3 The success of insulin therapy, however, depends on its physiologic properties as well as on its proper use. Barriers to patient use of subcutaneous insulin include anticipated pain, anxiety, inconvenience, fear of hypoglycemia, and concern about weight gain. Evidence suggests that patients may be reluctant to start insulin when prescribed or to delay starting treatment.4
This article discusses the topic of medicine and explains how insulin was discovered. Michael Bliss illustrates early on in the process of discovering insulin researchers kept hoping that by injecting people with a portion of pancreas they could cause an improvement in diabetes. In the summer of 1921 Banting and Best experiment “isletin” now known as insulin, was successful, however, James Collip PH.D in biochemistry had purified insulin allowing it to be more consistent and effective. This article is from The Canadian Encyclopedia, which is a credible source because it is professionally edit and fact-checked. The author Michael Bliss also has a PH.D from the University of Toronto and provides factual content that is extremely unbiased. This
Intermediate-acting insulin: Later than the injection it will starts working after two to fours and it will be in peak of four to twelve hours and with short – acting insulin or
In conjunction with the advancement in recombinant DNA technology, various insulin analogues have been produced which exhibit similar pharmacodynamics effects but modified pharmacokinetic properties. Insulin lispro, insulin aspart and insulin glulisine are the examples of rapid-acting insulin analogs which are commercially available in the clinical settings. Due to the reason of rapid onset and early peak action which closely mimic normal endogenous prandial insulin secretion as compared to regular insulin, rapid-acting insulins allow more physiologic prandial insulin replacement. On top of that, rapid-acting insulins permit to be taken immediately before the meal without sacrificing glucose
Carbohydrates, a primary source of energy for the body, are the sugars, starches, and fibers found in fruits, grains, vegetables, and milk products. The carbohydrates intake that I recorded reached the recommended level of carbohydrates intake. My intake of carbohydrate was 219.40 germs on the actual intakes list. Although it reached 80 percent of the recommended carbohydrates intake, my carbohydrate intake still below the goal in my calorie assessment report. Due to this, I should eat more vegetable or whole grains. Moreover, almost all my carbohydrates intake came from white rice, fruits, and noodles in my three-day diet food list. White rice, and noodles both contain high carbohydrates for
For people with type 1 and type 2 diabetes, counting carbohydrates is a way to match insulin requirements to the foods you eat and drink. For type 2 diabetics who don’t require insulin injections, carb counting is a way to monitor how carbs affect your blood glucose levels, manage your weight and medication intake.
Type 1 insulin is a result of deficiency of insulin present in the body. Whereas, Type II insulin is caused due to the resistance to Type 1 insulin. Therefore, there have been various types of insulin dosages characterized in the industry. They focus on the duration and how quickly they are capable of acting. They include, rapid, intermediate, short and long acting insulins. This will affect the type of dosages required to sustain good blood glucose levels. (Steiner, 2009)
Carbohydrates are not only present in packed and ready to eat food but also in natural agricultural foods like grains.
Insulin lispro (Humalog) manufactured by Eli Lilly and it is the first rapid insulin to receive approval by the FDA in 1996. The insulin sequence at the position B28 (proline) and B29 (lysine) reversed to form lispro figure (1). The onset of activity is 15 minutes, peak action 60-90 minutes, and duration (3-4 hours); injected shortly before meals (0-15 minutes). Therefore it stimulates physiological insulin secretion relative to meals. The FDA approved the insulin lispro (Humalog) for pediatric patients from 3 years and older, and it is pregnancy category
Carbohydrates are one of the important nutrients in our body which are our main source of energy for all body functions.
Pharmacokinetic studies have revealed that the peak plasma concentration of insulin lispro in the first hour after injection is twofold higher and that the time to maximum concentration of insulin lispro is less than half compared to that of human regular insulin. Compared with human regular insulin at the same time, insulin lispro leads to a lower postprandial glycaemic peak, shorter time to peak and lower total glucose excursion for the 0–4 h period. These characteristics enable insulin lispro to be injected within 15 min of starting a meal. ,
source of insulin but the challenge with this treat mean is the you do not know precisely how
The patient presented in this article was a 20 year-old diabetic female with a history of repeated hospital admissions due to diabetic ketoacidosis. It is well known that diabetes mellitus, with its complications, is an important risk factor for fungal urinary tract infections. Other risk factors include repeated hospitalizations, placement of urinary drainage devices and prior antibiotic treatment.
Insulin comes in many different forms and types. There is rapid acting, shot acting, intermediate acting, long acting, and even pre mixed insulin. Which type your patient is on depends on their specific needs.
I was surprised to learn this. For whatever reason I was under the impression that insulin was insulin. Conversely, there are different varieties of insulin available. Some brands that act quicker than others and some that are less expensive than others. Additionally, I discovered that there is an inhaled version of insulin. Finally, I learned about the GlucoStabilizer Program. This is a computerized program that tells the doctor exactly how much insulin a particular patient will need to keep their blood sugar in check. I have so often heard about patients adjusting dosages of insulin by trial and error, so I am really impressed to find out about this remarkable computer program and it’s use in maintaining normal blood glucose levels. I was glad for the opportunity to listen to the nurse’s lecture and learn a bit more about diabetes, she was certainly extremely knowledgeable about this disease. As with all of our guest speakers, I feel a bit more prepared as a PTA after having listened to this lecture and I am grateful to know that such a good resource person to know is out