The nurse assists an older man who has type 2 diabetes mellitus to improve his glucose control. Which of the following instructions does the nurse give to this individual when he plans to walk more than usual in one day?
a. Omit antidiabetic medication. c. Supplement caloric intake.
b. Wear sturdy open-toed shoes. d. Prepare to adminis-ter insulin.
C
Diabetes mellitus is controlled by balancing exercise, calories, and hypoglycemic medication; if one element of therapy is altered, then one or both of the remaining elements must be adjusted. When the patient's activity is going to metabolize more calories, the medication has to be re-duced or the calories have to increase. For a patient with type 2 diabetes mellitus, adjusting the medication can be difficult; therefore the nurse instructs this older adult to supplement his caloric intake, which can be accomplished by eating snacks during the walk or by increasing the gly-cemic load before walking. The patient ensures glucose control during these activities by testing his blood sugar levels. The nurse cannot tell the patient to omit medication because doing so is not within a nurse's scope of practice. The nurse instructs the older adult to wear closed, well-fitting leather shoes to protect the feet from trauma. Although many individuals with type 2 diabetes mellitus periodically take insulin, insulin is administered to induce hypoglycemia. Be-cause the individual plans to walk more than usual, more calories are needed to prevent hypog-lycemia.
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