A nursing home resident who has type 1 diabetes mellitus is gradually requiring more and more insulin on an as-needed (PRN) basis to treat hyperglycemia
Which of the following should the nurse assess to plan care for improving this individual's glucose metabolism? a. New-onset urinary tract infection
b. Trends over time in activity level
c. Sudden increase in caloric intake
d. Big change in diabetic medication use
B
Standard diabetic therapy includes diet, hypoglycemic agents, and exercise. If one aspect of the therapy changes, then the other two aspects must be adjusted to avoid hyperglycemia. Improving glucose metabolism is a huge benefit of exercise for the person with diabetes. In all people, exer-cise helps maintain aerobic conditioning, stabilizes mood, improves the quality of sleep, and is especially important for those with diabetes to promote and maintain collateral circulation. For this resident, a slow decline in physical activity will necessitate a change in the amount of insulin given or the total amount of daily calories to prevent hyperglycemia; however, the best solution for this resident is to increase daily physical activity. A new event is likely to cause an abrupt change in the serum glucose. Although infections are frequently detected in an individual with diabetes, infections are more closely associated with sudden-onset hyperglycemia. A sudden in-crease in caloric intake is likely to cause a sudden increase in blood glucose. A big change in medication use is likely to cause an abrupt change in the serum glucose.
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