Which of the following are complications of insulin therapy? (Select all that apply).
Lipodystrophy.
Dawn phenomenon.
Hypoglycemia.
Somogyi phenomenon.
Insulin resistance.
Correct Answer : A,C,E
Choice A rationale: Lipodystrophy is a complication of insulin therapy where changes in subcutaneous fat tissue occur at injection sites. Repeated injections in the same area can lead to either lipohypertrophy (a lump of fat) or lipoatrophy (a depression in the skin), which can impair insulin absorption. Rotating injection sites helps prevent this condition.
Choice B rationale: The dawn phenomenon is a physiological event, not a complication of insulin therapy. It is a morning hyperglycemia caused by the normal nocturnal release of counter-regulatory hormones like growth hormone and cortisol, which increase liver glucose production and cause blood sugar levels to rise. This is an endogenous process.
Choice C rationale: Hypoglycemia is a common and serious complication of insulin therapy. It occurs when insulin levels are too high relative to the available glucose, causing blood sugar to drop below 70 mg/dL. This can result from a missed meal, excessive exercise, or an incorrect insulin dose, leading to neuroglycopenic symptoms.
Choice D rationale: The Somogyi phenomenon, or rebound hyperglycemia, is a physiological response to insulin-induced hypoglycemia. An excessive insulin dose causes blood glucose to drop during the night, triggering the release of counter-regulatory hormones that cause rebound hyperglycemia in the morning. This is not a direct complication of the insulin itself but of its administration.
Choice E rationale: Insulin resistance is a complication where the body's cells become less responsive to the effects of insulin, requiring higher and higher doses to achieve the desired glycemic control. This can be caused by various factors, including obesity, inactivity, and the development of antibodies to insulin, impairing its ability to facilitate glucose uptake.
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Related Questions
Correct Answer is B
Explanation
Choice A rationale: Administering insulin intramuscularly is generally discouraged. The absorption of insulin from intramuscular sites is more rapid and can be unpredictable, increasing the risk of hypoglycemia. This is not a recommended method for routine insulin administration and does not address the issue of lipodystrophies, which are localized tissue changes resulting from repeated injections in the same area. The primary route is subcutaneous.
Choice B rationale: Lipodystrophies, which include lipohypertrophy (lumps of fat) and lipoatrophy (depressions in the skin), are localized tissue changes that result from repeated injections into the same exact spot. By rotating injection sites within and between different anatomical regions, the tissue has an opportunity to heal. This prevents the inflammatory response and subsequent fat deposition or breakdown that characterizes these localized complications.
Choice C rationale: Using human insulin has significantly reduced the incidence of immunogenic lipoatrophy compared to older animal insulins. However, it does not completely eliminate the risk of lipohypertrophy, which is a consequence of repeated local tissue trauma. Even with human insulin, it is essential to rotate sites to prevent this mechanical and inflammatory response.
Choice D rationale: Using insulin at room temperature is a recommended practice to reduce injection site discomfort, as cold insulin can be irritating to the tissue. This, however, is not a strategy to prevent lipodystrophies. Lipodystrophies are caused by mechanical and biochemical changes in the tissue from repetitive use of the same injection site, not by the temperature of the insulin itself.
Correct Answer is ["0.8"]
Explanation
Determine the volume of heparin to administer.
The ordered dose is 4000 units and the available concentration is 5000 units/mL.
The calculation is 4000 units ÷ (5000 units/mL) = 0.8 mL.
The nurse will administer 0.8 mL of heparin for this dose.
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