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Women’s Health Nurse Practitioner Exam Prep

Category - Women's Health Nurse Practitioner

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Your patient is a 17-year old teenage girl with Type I diabetes.  She has erratic blood glucose levels. She is on the school track team and works out in the afternoons for 1 ½ hours. Her meal plan consists of 3 meals, a pre-exercise snack of one fruit, and a bedtime snack of ½ cup of cereal and 1 cup of milk. Her insulin regimen is three units of regular insulin before breakfast and two units of regular insulin before dinner, and equal amounts of NPH mid-morning and bedtime. Lately, her pre-dinner blood glucose levels have been low. What would be the most effective nutrition intervention for her?
  1. Reduce the mid-morning NPH insulin by one unit and add a protein exchange to the afternoon snack.
  2. Increase the bedtime insulin and add another bread exchange to the bedtime snack.
  3. Reduce the afternoon exercise to 45 minutes and have her carry fruit juice with her in case she feels dizzy or weak.
  4. A & B
  5. None of the above
Explanation
Answer: A - A potentially effective intervention would be to reduce the mid-morning NPH insulin by one unit and add protein exchange to the afternoon snack. NPH is an intermediate-acting insulin that has its peak effect in the afternoon. Reducing the amount of NPH by one unit and adding protein to the pre-exercise snack will help eliminate low blood glucose levels before the evening meal.  Note the NPH insulin dosage change would need to be performed by a physician who can prescribe the change.  A consultation with a nutritional advisor such as RD or CNS should also be considered.
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