Medical Surgical Diabetes #7

Question

A client with Type 2 diabetes asks the nurse why insulin injections are necessary after surgery since only oral hypoglycemics are taken while at home. Which statement by the nurse best explains the likely cause for this short-term change in treatment?

Answers

  1. “Surgical procedures may alter normal glucose because of stress on the body.”
    • Rationale:

      This answer is correct because a client with type 2 diabetes who does not generally use insulin therapy at home may need insulin while in the hospital or having surgical procedures. This is because stress from illness or surgery increases stress hormones, which elevate blood glucose levels. Anesthesia may also play a role in affecting blood glucose. Insulin administration postoperatively may be temporary and will not necessarily need to be continued at home.

  2. “Once insulin injections occur they might need to continue while at home.”
    • Rationale:

      This answer is not correct because insulin administration postoperatively may be temporary and will not necessarily need to be continued at home. This is because stress from illness or surgery increases stress hormones, which temporarily elevates blood glucose levels.

  3. “Insulin must be given because the infusion solutions are heavily concentrated with sugars.”
    • Rationale:

      This answer is not correct because the surgeon can control the amount of dextrose the client is receiving and would not give extra IV dextrose, unless needed. Insulin is given temporarily to the client because stress from illness or surgery increases stress hormones, which temporarily elevates blood glucose levels.

  4. “It is easier for the staff to manage blood sugars if insulin protocol is followed.”
    • Rationale:

      This answer is not correct because insulin is not administered for the convenience of the staff. Insulin is given temporarily to the client because stress from illness or surgery increases stress hormones, which temporarily elevates blood glucose levels.

Overview

A client with Type 2 diabetes who does not normally need insulin injections may need insulin short-term during hospitalization or surgical procedures. The nurse should educate the client about the need for short-term insulin related to the effects of stress on the body altering blood glucose.

Explanation

Learning Outcomes

A client with type 2 diabetes who does not generally use insulin therapy at home may need insulin while in the hospital or having surgical procedures. This is because stress from illness or surgery increases stress hormones, which elevate blood glucose levels. Glycemic control during the postoperative stage may be difficult due to stress on the body resulting in excess cortisol and catecholamine levels. Anesthesia may also play a role in affecting blood glucose. Insulin administration postoperatively may be temporary and will not necessarily need to be continued at home.

Test Taking Tip

Understanding the effect of stress and illness on a diabetic is extremely important. Stress and illness can cause the client to be more susceptible to elevated blood glucose, not healing as well, and infection, therefore causing a need for insulin (if generally not taken) or additional insulin (if already taking insulin).

Video Rationale