CONCEPT: Glucose Regulation
EXEMPLARS: Diabetes Mellitus Type 1 and Type 2
Instructions: Fill in the grid below to compare/contrast type 1 diabetes with type 2 diabetes.
Diabetes Mellitus
Type 1
The pancreas produces
little or no insulin.
Diabetes Mellitus
Type 2
Body resists the effects
of insulin or doesn’t
produce enough insulin
to maintain normal
glucose levels
What is different?
Assessments – what
signs and symptoms
would you expect to
see
Increased thirst
Frequent urination
Bed-wetting in children
Extreme hunger
Unintended weight loss
Fatigue and weakness
Increased thirst
Frequent urination
Fatigue
Weight loss
Frequent sores
Areas of darkened skin
Type 2 has darkened
areas of skin and more
infections and slow
healing sores. Type 1
has bed wetting
because it is diagnosed
in childhood
Labs and Diagnostics –
What tests would you
expect, and specific
values or results that
are significant
A1C ≥ 6.5%’
OR
8-hour fasting blood
glucose level of > 126
mg/dl
OR
Oral glucose tolerance
test of 200mg/dl or
more in a 2-hour
sample
OR
Random blood glucose
level of 200mg/dl or
more accompanied by
classic signs of diabetes
A1C test: 6.5% and
higher on two separate
tests
Random blood sugars
or 200 or higher
In type 2 diabetes, the
main indicator is the
A1C test while in type 1
the blood sugar is the
main test
Medications – what
medications would you
expect to be prescribed
for this disease
process?
Rapid-acting insulin
Short-acting insulin
Intermediate acting
insulin
Long-acting insulin
Metformin
Insulin
Meglitinides
Thiazolidinediones
DPP-4 inhibitors
Type 2 has oral
medications, not just
insulin unlike type 1
Brief Pathophysiology
Type 2 is usually adult
onset and type 1 is
usually childhood onset
Type 2 deals more with
the body resisting
insulin
Acute Complications –
What acute
complications would
you monitor for?
Hypoglycemia
Diabetic ketoacidosis
Long Term
Complications – What
long term
complications are you
concerned about?
Microvascular
complications: eye,
kidney and nerve
disease (neuropathy)
Heart disease
Foot damage
Monitor for
hypoglycemia and
diabetic ketoacidosis
Patient Education –
what educational
needs would you
anticipate with a new
diagnosis?
Hypoglycemia
Hyperosmolar
hyperglycemic
nonketoic syndrome
(high blood glucose)
Neuropathy
Kidney and eye
damage
Hearing impairment
Sleep apnea
High BP
Eating low fat and
calorie food.
Exercise
Type 2 diabetes has the
HHS, not type 1
diabetes
Sleep apnea because of
obesity in type 2 not in
type 1
type 2 has losing
weight because obesity
contributes to type 2
Diabetes Medication Review Questions
1. Which is the most appropriate timing regarding the nurse's administration of a rapid-acting
insulin to a hospitalized patient?
a. Give it 15 minutes before the patient begins a meal.
b. Give it ½ hour before a meal.
c. Give it 1 hour after a meal.
d. The timing of the insulin injection does not matter with insulin lispro.
2. Which statement is appropriate for the nurse to include in patient teaching regarding
type 2 diabetes?
a. “Insulin injections are never used with type 2 diabetes.”
b. “You don't need to measure your blood glucose levels because you are not taking
insulin injections.”
c. “A person with type 2 diabetes still has functioning beta cells in his or her
pancreas.”
d. “Patients with type 2 diabetes usually have better control over their diabetes than
those with type 1 diabetes.”
3. The nurse monitoring a patient for a therapeutic response to oral antidiabetic drugs
will look for:
a. fewer episodes of diabetic ketoacidosis (DKA).
b. weight loss of 5 pounds.
c. hemoglobin A1C levels of less than 7%.
d. glucose levels of 150 mg/dL.
4. A patient with type 2 diabetes is scheduled for magnetic resonance imaging (MRI)
with contrast dye. The nurse reviews the orders and notices that the patient is
receiving metformin (Glucophage). Which action by the nurse is appropriate?
a. Proceed with the MRI as scheduled.
b. Notify the radiology department that the patient is receiving metformin.
c. Expect to hold the metformin the day of the test and for 48 hours after the test is
performed.
d. Call the prescriber regarding holding the metformin for 2 days before the MRI is
performed.
5. A patient with type 2 diabetes has a new prescription for repaglinide (Prandin). After
1 week, she calls the office to ask what to do, because she keeps missing meals. “I
work right through lunch sometimes, and I'm not sure whether I need to take it.
What do I need to do?” What is the nurse's best response?
a. “You need to try not to skip meals, but if that happens, you will need to skip that
dose of Prandin.”
b. “We will probably need to change your prescription to insulin injections because
you can't eat meals on a regular basis.”
c. “Go ahead and take the pill when you first remember that you missed it.”
d. “Take both pills with the next meal, and try to eat a little extra to make up for
what you missed at lunchtime.”
6. Which action will the nurse recommend to a client with type 1 diabetes on insulin
therapy who has been having a morning fasting blood glucose (FBG) level of 160
mg/dL and is diagnosed with “Somogyi phenomenon” to achieve better control?
a. “Avoid eating any carbohydrate with your evening meal.”
b. “Eat a bedtime snack containing equal amounts of protein and carbohydrates.”
c. “Inject the insulin into your arm rather than in the abdomen right around the
navel.”
d. “Take your evening insulin dose right before going to bed instead of at supper
time.”