Question

The patient, Juan Carlos, has just returned after surgical debridement of a diabetic foot ulcer on his right great toe. The procedure was done under local anesthesia, and I would like to give you a report on him before I hand him over to you.

Mr. Carlos is a 52-year-old Hispanic male with a history of type 2 diabetes mellitus, hypertension, and hyperlipidemia who presented in the emergency department last night complaining of pain in a wound on his right great toe. He states he dropped a large rock on his toe several weeks ago and sustained an open wound. The pain had been increasing over the last days, and he was unable to get the pain under control. He was then admitted for surgical debridement of what showed to be a diabetic ulcer and to receive antibiotic treatment.

This morning at 0730 Mr. Carlos’s blood sugar was 225 and he received 4 units of insulin aspart, a sliding scale insulin, along with his regular medications before the surgery. It is all in the MAR. He also received his antibiotic treatment this morning as prescribed. The surgery was performed under local anesthesia. He was given one tablet of oxycodone 5 mg/acetaminophen 325 mg for his pain after surgery. He now reports his pain to be 3 out of 10. He has a dressing on the toe and a right forearm IV that is saline locked. The dressing on his toe is dry and intact. He seems to be doing well, and his wife has just been here to see him.

He is due for a check of blood sugar level and vital signs. The provider has just updated the orders, so please take a look at the patient chart to see all details.

Will the patient's high blood sugars and history of diabetes have any effect on his recovery?

Discuss the different types of sliding scale insulins.

Answer 1

Yes it affects the recovery of the patient.An infection is concern because of the healing ability because in diabeteic patient immune system system is not working adequately as result wound healing takes longer time so it is important to control the blood glucose level. High sugar level may constrict blood vessels and it cause decreased blood flow to the body and affect the nerves and decreadse the wound healing.

Insulin is used to treat diabeteic mellitus patient when diet and other measures are in effective.Therea are different types of sliding scale insulin are used. They are:

1)Rapid Acting Insulin:Insulin aspart,Insulin glulisine

2)Short Acting Insulin:HumulinR,Novolin R

3)Intermediate-Acting Insulin:Humulin N,Novolin N

4)Long Acting Insulin:Insulin Lantus