Assignment problem: Solomon is a 60-year-old West Indian male from the Greater Toronto Area (GTA) in Ontario who comes to the Emergency Department with his wife of 22 years. Solomon has been complaining of nausea and vomiting over the last 2-3 days, and his partner James states he seems confused at times. His blood sugar on arrival at the department reads 19.6 mmol/L. Solomon has already been started on regular insulin (Humulin R) via the SQ route, and he will be admitted for further investigation and diagnostic purposes. This is a new diagnosis of diabetes for Solomon, and he is very anxious. Solomon is 5 feet 7 inches tall and weighs 181 pounds. He reports no form of regular exercise or a special diet. Solomon's diet entails carbohydrate-dense foods and high glycemic index beverages. Over the past four months, his partner has noticed that Solomon has been thirsty and goes to the bathroom every 30-60 minutes.
Question 1: What is the role of insulin in type 2 diabetes?
Question 2: What is the rationale for using oral antihyperglycemic drugs in patients with type 2 diabetes? Why do some patients with type 2 diabetes need to begin taking insulin? What can be used to measure the control of the patient's diabetes over the short term and long term?
Question 3: Solomon asks the nurse, "How many insulin injections will I require daily?" What factors may determine the frequency and type of insulin Solomon may require once discharged? How should the nurse respond?