The physician orders Humulin NPH insulin 20 units plus Humulin R insulin 11 units subcutaneous every evening. The medication is supplied in 100 units/mL. How many units will the nurse administer?

Choice A rationale: Stroke, also known as a cerebrovascular accident, is a significant macrovascular complication of diabetes mellitus. Chronic hyperglycemia damages the endothelial lining of blood vessels, leading to the formation of atherosclerotic plaques. These plaques can rupture, forming thrombi that obstruct blood flow to the brain, causing ischemic stroke. Hypertension, a common comorbidity, also increases stroke risk by damaging vessel walls.
Choice B rationale: Kidney failure, specifically diabetic nephropathy, is a major microvascular complication. Persistent hyperglycemia causes glomerular hyperfiltration and damage to the small blood vessels and filtering units (glomeruli) in the kidneys. This leads to protein leakage (albuminuria), which progresses to a decrease in the glomerular filtration rate, ultimately resulting in end-stage renal disease and the need for dialysis or kidney transplantation.
Choice C rationale: Blindness, specifically diabetic retinopathy, is a primary microvascular complication. Chronic high blood glucose levels damage the tiny capillaries supplying the retina, causing them to leak fluid or close off completely. This can lead to the growth of new, fragile blood vessels (proliferative retinopathy) that are prone to bleeding, scarring, and retinal detachment, causing irreversible vision loss or blindness.
Choice D rationale: Respiratory failure is not a direct complication of diabetes mellitus. While conditions like diabetic ketoacidosis can lead to Kussmaul respirations (deep, rapid breathing) as a compensatory mechanism, this is not considered respiratory failure. Respiratory failure is more often associated with primary pulmonary diseases, severe infections, or neuromuscular disorders.
Choice E rationale: Cirrhosis, a late-stage liver disease, is not a direct complication of diabetes mellitus. While non-alcoholic fatty liver disease (NAFLD) is prevalent in individuals with diabetes and metabolic syndrome, and can progress to cirrhosis, it is not an inevitable or direct consequence of the disease itself. Cirrhosis is more directly caused by chronic viral hepatitis, alcohol abuse, or other liver diseases.

Choice A rationale: The abdomen is actually the preferred site for insulin injections due to its consistent and rapid absorption rate compared to other sites. While absorption can vary slightly depending on the specific location within the abdomen, it is considered more predictable than other areas. Avoiding the abdomen would eliminate a prime injection site, which would make proper site rotation more difficult to achieve.
Choice B rationale: Choosing a different site at random for each injection is not the recommended approach. While it ensures rotation, it can make it difficult to monitor for site reactions or track the effectiveness of different injection sites. A systematic rotation strategy is preferred to ensure that all areas are used appropriately and consistently over time, preventing tissue damage.
Choice C rationale: Giving the injection in the same area each time, or even in the same exact spot, is the primary cause of lipohypertrophy and lipoatrophy. Repeated trauma to the same tissue leads to fibrous tissue formation and fat deposition or breakdown, which can significantly alter insulin absorption, making glycemic control unpredictable and increasing the risk of both hypoglycemia and hyperglycemia.
Choice D rationale: Rotating sites within the same anatomical location, such as the abdomen, for approximately one week before moving to a new location (e.g., the thigh or arm), is the recommended practice. This systematic approach ensures that tissue at the injection sites has time to heal, preventing the development of lipodystrophies. It also helps maintain consistent insulin absorption.