A patient with type 2 diabetes mellitus, which was previously controlled with an oral antidiabetic agent, is hospitalized for treatment of a leg ulcer

Question

The health care provider has ordered sliding scale insulin coverage with regular insulin for hyperglycemia. The nurse brings the injection into the room, and the patient becomes upset, stating "I don't want to start taking that drug! I'll need it the rest of my life." What is the nurse's best response?
a. "This is the same drug as the oral medication you were taking. It's a stronger dose while you are in the hospital."
b. "Don't worry. You shouldn't need this too often. As you feel better, your blood glucose level will drop."
c. "Your body is under stress right now, which raises your blood glucose level. This does not mean you will be on this drug permanently. Once you're feeling better, your provider will determine if your oral medication is all you will need."
d. "Your disease is progressing and your pancreas is producing less insulin. I know this is a hard time for you. Do you want to talk about it?"

Answer 1

ANS: C
Type 2 diabetes mellitus patients normally controlled with oral hypoglycemics may require insulin during situations of increased physiologic and psychological stress. The stress response stimulates epinephrine and norepinephrine, which raises the blood glucose level. Examples of stressors include pregnancy, surgery, and infections.