Problem
K.W., a 25-year-old Hispanic female, who was just released from the hospital 2 days ago after being diagnosed with type 1 DM.
Nine days ago, K.W. went to see the physician after a 1-month history of frequent urination, thirst, severe fatigue, blurred vision, and someburning and tingling in her feet. She attributed those symptoms toworking long hours at the computer. Her random glucose level was 410mg/dl. The next day, her labs were as follows: fasting glucose 335mg/dl, HbA1C 8.8%, cholesterol 310 mg/dl, triglycerides 300 mg/ dl,HDL 25 mg/dl, LDL 160 mg/dl, ratio 12.4, creatinine 0.9 mg/dl, and body mass index 37.6. Her BP is 160/96 mm Hg. She was admitted to the hospital for control of her glucose levels and the initiation of multi-dose injection insulin therapy with carbohydrate (CHO) counting. After discharge, K.W. has been referred to you for comprehensive education. You are to cover four basic areas: pharmacotherapy, glucose monitoring, medical nutrition therapy (MNT), and exercise.
I. KW. was started on sliding scale lispro (Humalog) four times daily and glargine (Lantus) insulin 30 units at bedtime. What is the mostsignificant difference between these two insulins?
II. What is the peak time and duration for lispro insulin?
III. KW. states that she knows people who take NPH and regular insulin and wants to know why she can't take them. Explain the advantages of using glargine (Lantus) and lispro (Humalog) insulins.
IV. Identify important content to be included under pharmacologictherapy.
V. What specific points would you include in a teaching plan for K.W regarding managing insulin therapy? Select all that apply
i. Always administer the injections in the same, easy-to-reach location.
ii. Two injections will be needed to administer lispro(Humalog) and glargine (Lantus).
iii. The current vial of lispro (Humalog) can be kept atroom temperature for l month.
iv. Ideally, the glargine (Lantus) should be administered atbedtime.
v. The insulin can still be used if it is yellowed but notexpired.
vi. Unused insulin needs to be kept in the freezer.
vii. Administer the lispro (Humalog) within 15 minutes ofeating.
VI. Identify important content to be included under glucose monitoring.
VII. K.W. states that her diet is mostly fast foods, and the foods cooked at home are high in starch and fat. She also states that because of her work schedule, mealtimes often vary from day to day. What is CHO counting, and why would this method work well for K.W?
VIII. Identify important points to be covered under MNT.
IX. K.W. states that she currently does not exercise at all. What benefits will K.W. receive from participating in an exercise program?
X. What do you need to teach K.W. regarding exercise precautions?