Case # 1
Jabar is a 19 year old male who has been recently diagnosed with Type I Diabetes
and is having difficulty managing blood sugars. He is distraught with the idea of
having to do finger sticks to monitor blood glucose and with having to watch diet.
You are the diabetic nurse practitioner who is scheduled to talk with him about
long term management of his diabetes.
1. What is the primary pathology?
2. What treatment will be needed? For how long?
3. What information do you need to be able to do diabetic teaching?
Here is the information re: eating patterns that Jabar provided to you.
Out of bed – 0830
Breakfast – not consistent with eating breakfast; if eat it – 0930
Lunch – 1400-1500
Snack usually chocolate around 1730
Dinner – varies between 2000-2100
Diagram Jabar’s dietary patterns AND design the pattern of insulin administration
that would work best for him to allow coverage for his current dietary intake.
Refer to your knowledge of insulin, including onset, peak and duration. Be able to
support the administration plan you design for insulin administration.
Questions?
1. What did you consider in making this plan?
2. What teaching opportunities are there for working with Jabar?
3. Would he be a candidate for ‘tight glucose control’ therapy?
4. What happens when he misses a dose of insulin?
5. What happens when he takes his insulin but forgets to eat?
6. What happens when he loads up on food prior to a big workout?
 Jabar has been planning to start to train and then run a marathon. What is the
impact on the insulin regimen?
 Do you have ideas for how to make diabetic teaching for this patient more
efficacious?
Case # 2
Anna is 63 y/o and has been managing her diabetes for the last 7 years. You look
at the medications bottles that she has brought into clinic (you asked her to do
this) and note the following medications:
Metformin (Glucophage)
Tolbutamide (Orinase)
Glipizide (Glucotrol)
Alpha Glucosidase Inhibitor
1. What are your impressions of this treatment regimen for Anna?
2. What side effects are you worried about with these drugs?
3. What will you talk with the patient about related to this drug regimen?
Miscellaneous questions:
1. Can you mix a clear with a cloudy insulin?
2. What needs to be done when administering NPH insulin?
3. Why is insulin considered a ‘high alert’ medication?
4. Is ‘Regular insulin 14 U subcut stat’ an appropriate order? Why or why not?
5. What sites will you use in your diabetes management plan of care?