Nicholas Jefferson is 8 years old and has just been diagnosed with type 1 diabetes. After increasing symptoms during the past month, he was hospitalized for continuous nausea, vomiting, and gradually...

Nicholas Jefferson is 8 years old and has just been diagnosed with type 1 diabetes. After increasing symptoms during the past month, he was hospitalized for continuous nausea, vomiting, and gradually increasing lethargy. His parents report that over the past month or two, Nicholas has had blurry vision and has been thirsty and hungry constantly. He has been eating frequently but does not seem to be gaining any weight. They also tell you that on several occasions, Nicholas has wet the bed, which is very unusual for him. On admission, his serum glucose level is 420 mg/dL with a urine sample positive for glucose and ketones. Nicholas is to remain NPO and will be started on an IV with 0.45 normal saline for fluid replacement, given an IV bolus of insulin, and then started on an insulin drip at 0.5 unit per hour. Finger-stick glucose levels are to be checked every hour with serum blood glucose levels drawn every 4 hours. The IV insulin drip is to be discontinued when Nicholas’s blood glucose level is 240 mg/dL and subcutaneous insulin will be started at that time.

1. What type of insulin do you anticipate using for the IV bolus dose and IV drip?

2. Why do you think the insulin IV will be stopped when the blood glucose level is 240 mg/dL and not at the normal level of 70 to 100 mg/dL?

3. What essential teaching will Nicholas and his family need at this time?