Medical Surgical Labs Diabetic Labs #1

Question

A type 1 diabetic client who is compliant with his insulin has a hemoglobin A1C of 9.2% from 7.1% three months ago. Client reports he fasted before the lab draw. Which action is best?

Answers

  1. Refer to a nutritionist who specializes in diabetes and encourage the client to exercise.
    • Rationale:

      This answer is not correct because the client is a type 1 diabetic. Type 1 diabetics require insulin and with an increase in A1C over 6.5%, an insulin revision is indicated.

  2. Assess the diabetic medications the client is taking so the HCP can prepare to revise.
    • Rationale:

      This answer is correct because it is the best action for a type 1 diabetic. A type 1 diabetic requires a revision in insulin if the A1C rises above 6.5%. Diet and exercise is also important; however, in a type 1 diabetic, insulin is necessary.

  3. No action required, continue to monitor.
    • Rationale:

      This answer is not correct because the A1C is too high and needs to be addressed. Typically this is addressed with a type 1 diabetic by revising insulin.

  4. Have the labs repeated.
    • Rationale:

      This answer is not correct because the client reports he fasted before the lab study. The best action is to revise his insulin.

Overview

A type 1 diabetic should have a hemoglobin A1C below 6%. If it increases above 6.5%, insulin should be revised.

Explanation

Learning Outcomes

Hemoglobin A1C should be under 6%. If it rises above 6.5% in the client with type 1 diabetes who is compliant with their present dose of insulin, the insulin should be revised, as it is not adequately controlling blood glucose levels. If the client is a type 2 diabetic, typically diet and exercise is tried before initiation of insulin. It is important to weigh all factors that could potentially cause hyperglycemia. These include infection, steroids, or noncompliance of taking insulin.

Test Taking Tip

Remember actions between a type 1 diabetic and type 2 diabetic may differ. The type 1 diabetic will have a revision in insulin if blood glucose control is not maintained on the current regimen. A nondiabetic client or type 2 diabetic will start with diet and exercise before proceeding with medication changes.

Video Rationale