LPN Diabetes Care: Glucose and Insulin 5 — Questions and Answers
Question 1: A patient on insulin therapy reports eating extra food to prevent hypoglycemia. What is the most important education point the nurse should address?
- Extra food raises blood glucose and weight without preventing hypoglycemia caused by excess insulin (Correct answer)
- Snacking before exercise is always appropriate and should be encouraged freely
- Carbohydrate counting is not necessary for patients on basal insulin alone
- The patient should simply reduce the insulin dose without provider guidance
Correct answer: Extra food raises blood glucose and weight without preventing hypoglycemia caused by excess insulin
Overeating to prevent hypoglycemia leads to hyperglycemia and weight gain; the underlying insulin dose or timing should be reassessed with the provider.
Question 2: A nurse is assessing insulin injection sites on a patient who always injects in the same spot. What complication should the nurse look for?
- Lipohypertrophy—a lumpy, fatty buildup that impairs insulin absorption (Correct answer)
- Lipoatrophy only occurs with older animal-derived insulins, so it is not a concern
- Bruising alone is the only expected complication of repeated injections
- Scar tissue at the injection site increases insulin absorption
Correct answer: Lipohypertrophy—a lumpy, fatty buildup that impairs insulin absorption
Repeated injections in the same site cause lipohypertrophy, making absorption erratic and unpredictable, which destabilizes glucose control.
Question 3: Which statement correctly describes the relationship between exercise and blood glucose in a patient with type 1 diabetes?
- Exercise generally lowers blood glucose but can cause hyperglycemia if the patient is insulin-deficient at the time of exercise (Correct answer)
- Exercise always lowers blood glucose, so insulin doses should be doubled on active days
- Exercise has no significant effect on blood glucose in type 1 diabetes
- Only aerobic exercise affects blood glucose; resistance training does not
Correct answer: Exercise generally lowers blood glucose but can cause hyperglycemia if the patient is insulin-deficient at the time of exercise
Exercise increases glucose uptake in muscles (lowering glucose), but without adequate insulin, counter-regulatory hormones can drive hepatic glucose output and worsen hyperglycemia.
Question 4: A newly diagnosed diabetic patient asks why the provider ordered both insulin glargine at bedtime and insulin aspart with meals. What is the best explanation?
- Glargine covers background insulin needs 24 hours a day, while aspart controls the glucose spike that occurs after eating (Correct answer)
- Glargine is given at bedtime because it only works during sleep
- Aspart is a long-acting insulin that keeps glucose stable between meals
- The two insulins are interchangeable; this regimen doubles the safety margin
Correct answer: Glargine covers background insulin needs 24 hours a day, while aspart controls the glucose spike that occurs after eating
A basal-bolus regimen mimics normal pancreatic function: basal insulin (glargine) suppresses hepatic glucose between meals and overnight; bolus insulin (aspart) covers postprandial glucose excursions.
Question 5: Which of the following patients is at highest risk for hyperosmolar hyperglycemic state (HHS)?
- An elderly patient with type 2 diabetes who develops pneumonia and reduced oral intake (Correct answer)
- A 16-year-old with type 1 diabetes who skips a meal
- A type 2 diabetic patient on metformin with a fasting glucose of 140 mg/dL
- A pregnant patient with gestational diabetes on diet control alone
Correct answer: An elderly patient with type 2 diabetes who develops pneumonia and reduced oral intake
HHS typically affects older type 2 diabetic patients during acute illness; the combination of reduced fluid intake, impaired thirst, and stress hyperglycemia drives extreme hyperosmolarity.
Question 6: A patient's blood glucose before lunch is 245 mg/dL. The sliding scale orders 4 units of regular insulin for glucose 201–250 mg/dL. The patient also has a scheduled mealtime dose of 8 units of regular insulin. What total dose should the LPN prepare?
- 12 units (8 scheduled + 4 correction) (Correct answer)
- 4 units (correction dose only; skip scheduled dose when glucose is high)
- 8 units (scheduled dose only; never add correction at mealtime)
- 16 units (double the scheduled dose when glucose exceeds 200)
Correct answer: 12 units (8 scheduled + 4 correction)
Scheduled mealtime insulin and sliding-scale correction insulin are additive; both are given together and drawn into the same syringe if both are regular insulin.
Question 7: A patient with diabetes and chronic kidney disease (CKD) stage 4 is at increased risk for which insulin-related problem?
- Prolonged hypoglycemia because the kidneys normally degrade insulin and this capacity is reduced (Correct answer)
- Insulin resistance requiring higher doses due to uremic toxins
- Rapid insulin clearance leading to frequent hyperglycemia
- No change in insulin pharmacokinetics with CKD
Correct answer: Prolonged hypoglycemia because the kidneys normally degrade insulin and this capacity is reduced
The kidneys contribute significantly to insulin degradation; as renal function declines, insulin half-life extends and hypoglycemia risk increases, often requiring dose reductions.
LPN Diabetes Care: Glucose and Insulin 5
A patient on insulin therapy reports eating extra food to prevent hypoglycemia.
What is the most important education point the nurse should address?