The nurse discussing "sick day rules" with a newly diagnosed patient with type 1 diabetes is aware that the patient will require further teaching when he states:

Question

A) "I will not take my insulin on the days when I am sick, but I will check my blood sugar every 2 hours."
B) "If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding 6 to 8 times a day."
C) "I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea."
D) "I will call the doctor if my blood sugar is over 300 (mg/dL) or if I have ketones in my urine."

Answer 1

Ans: A
Feedback: The nurse must explain the "sick day rules" again, emphasizing that the patient should take insulin agents as usual and test his blood sugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring patients may need supplemental doses of regular insulin every 3 to 4 hours. The patient should report elevated glucose levels (greater than 300 mg/dL or as otherwise instructed) or urine ketones to the physician. If the patient is not able to eat normally, he should be instructed to substitute soft foods such a gelatin, soup, or pudding. If vomiting, diarrhea, or fever persists, the patient should have an intake of liquids every 1/2 hour to 1 hour to prevent dehydration. Fluid loss is dangerous; nausea, vomiting, and diarrhea should be reported to the physician. Patients with type 1 diabetes who cannot retain oral fluids may need hospitalization to avoid diabetic ketoacidosis and possibly coma.