Case Study #2

Patient Name: Jacob M.

Age: 17

Diagnosis: Type 1 Diabetes Mellitus (T1DM)

History: Diagnosed at age 10, uses insulin pump therapy, active in sports

Situation:

Jacob is brought to the emergency department by his coach after collapsing during basketball practice. He is unconscious, diaphoretic, and unresponsive to verbal stimuli. A bedside glucose check reveals a blood sugar of 28 mg/dL. VS are temp. 97 F, HR 112, RR 12, BP 104/48, 02 sat 96%.

The nurse prepares to administer 1 mg of glucagon IM as per the emergency protocol.
After administering glucagon, what is the nurse's next priority action?

A. Eat a high-protein diet: A high-protein diet is not specifically recommended for improving blood glucose control in type 2 diabetes. A balanced diet with a focus on carbohydrates, fiber, and portion control is more effective for long-term management.

B. Lose weight: Weight loss is one of the most effective ways to improve blood sugar control in type 2 diabetes. It reduces insulin resistance, enhances insulin sensitivity, and leads to better overall glucose management.

C. Take insulin: Insulin is typically not the first treatment for type 2 diabetes, especially in individuals who are overweight. Lifestyle changes, including diet and exercise, are generally prioritized before moving to insulin therapy.

D. Take more metformin (Glucophage): While metformin is an important medication, weight loss through lifestyle modifications often has a more significant and lasting impact on blood sugar control than simply increasing the dosage of medication.

A. Prevent diabetic coma: A diabetic coma (such as diabetic ketoacidosis or hyperosmolar hyperglycemic state) is not the primary concern related to insulin administration. It is associated with severe hyperglycemia, not with the need for a snack to balance insulin action.

B. Improve nutrition: While the snack may help with overall nutrition, it is not primarily intended to improve nutrition in this scenario. The goal is to maintain blood sugar levels within a safe range, particularly after insulin administration.

C. Improve carbohydrate metabolism: The primary goal of the mid-afternoon snack is not to directly impact carbohydrate metabolism. The snack is designed to maintain glucose levels after insulin has been administered.

D. Prevent an insulin reaction: The snack is likely provided to prevent hypoglycemia or an insulin reaction (low blood sugar). Humulin N insulin is an intermediate-acting insulin, and its peak action occurs several hours after administration. The snack helps prevent low blood sugar by providing a source of glucose to balance the insulin effect.