The nurse is teaching a group of patients about management of diabetes. Which statement about basal dosing is correct?
Basal dosing delivers a constant dose of insulin.
With basal dosing, you can eat what you want and then give yourself a dose of insulin.
Glargine insulin is given as a bolus with meals.
Basal-bolus dosing is the traditional method of managing blood glucose levels.
The Correct Answer is A
Choice A rationale: Basal dosing involves a continuous, low-level release of insulin throughout the day and night to mimic the pancreas's natural basal insulin secretion. This helps to maintain stable blood glucose levels between meals and overnight, preventing hyperglycemia. Long-acting insulins like glargine or detemir are used for this purpose.
Choice B rationale: This statement describes bolus or prandial insulin dosing, not basal dosing. Bolus insulin is administered before meals to manage the anticipated rise in blood glucose from food intake. Basal insulin provides a constant background level and does not correlate with specific meals.
Choice C rationale: Glargine is a long-acting basal insulin. It is designed to be given once or twice a day to provide a steady, continuous insulin level. Bolus insulin, such as lispro or aspart, is given with meals to cover the carbohydrate intake. Glargine should never be used as a bolus with meals due to its delayed onset and peakless profile.
Choice D rationale: Basal-bolus dosing is the modern, intensive method of managing blood glucose, not the traditional one. The traditional approach often involved fixed-dose insulin regimens. Basal-bolus therapy, which combines long-acting basal insulin with short-acting bolus insulin, is a more flexible and effective approach that more closely mimics normal pancreatic function.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale: Hyperglycemia results from a lack of insulin, leading to an inability of cells to uptake glucose. Glucagon functions as a hormone that stimulates the liver to convert stored glycogen into glucose, thereby raising blood glucose levels. Administering glucagon in an already hyperglycemic state would exacerbate the condition, potentially leading to a dangerous spike in blood sugar. It's used for low, not high, blood sugar.
Choice B rationale: Hypoglycemia, a dangerously low blood glucose level (typically below 70 mg/dL), can be caused by an overdose of insulin, which drives too much glucose into cells. Glucagon is a hormone that counteracts insulin's effects by stimulating glycogenolysis in the liver, releasing stored glucose into the bloodstream. This rapid increase in circulating glucose effectively treats the acute hypoglycemic episode, making it an essential emergency treatment.
Choice C rationale: Diabetic ketoacidosis (DKA) is a severe metabolic complication of diabetes characterized by hyperglycemia, ketosis, and metabolic acidosis. It is caused by an absolute or relative lack of insulin. Administering glucagon would increase blood glucose levels even further, worsening the hyperglycemia, which is a primary component of DKA. Insulin and fluid replacement are the mainstays of treatment for DKA.
Choice D rationale: Hyperglycemia during 'sick days' is a common phenomenon in people with diabetes due to increased stress hormones like cortisol and epinephrine, which raise blood glucose. Administering glucagon would further elevate blood sugar, intensifying the existing hyperglycemia. Therefore, glucagon is contraindicated in this scenario, as it would worsen the metabolic state rather than improving it.
Correct Answer is B
Explanation
Choice A rationale: Certain antibiotics, such as fluoroquinolones, can cause both hypo- and hyperglycemia, but this effect is less common and less pronounced than the effect of corticosteroids. The significant and sustained increase in blood glucose is more characteristic of steroid use, which is a known and common side effect.
Choice B rationale: Corticosteroids stimulate gluconeogenesis in the liver and reduce glucose uptake in peripheral tissues, leading to insulin resistance. This combination results in a significant increase in blood glucose levels, a phenomenon known as steroid-induced hyperglycemia. The patient's type 2 diabetes exacerbates this effect.
Choice C rationale: Type 2 diabetes does not convert to type 1 diabetes. These are distinct pathophysiological conditions. Type 1 is an autoimmune disease with absolute insulin deficiency, while type 2 involves insulin resistance and relative deficiency. The current elevated glucose is an acute, reversible effect of medication, not a change in the underlying disease.
Choice D rationale: While hypoxia can lead to a stress response that increases blood glucose, it is not the primary cause of this sustained elevation in a patient on corticosteroids. The direct metabolic effects of corticosteroids on glucose metabolism are the most significant and likely cause of the observed hyperglycemia.
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