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Chapter 7 CARE OF THE PATIENT WITH ENDOCRINE DISORDERS 341

Complications of Insulin Therapy

1. Allergic reactions – Local reactions to insulin administration could include
inflammation, burning, itching, or redness around the injection site. Could
improve with a low dose of antihistamine. Urticaria or hives can signal a
more systemic reaction, with anaphylactic shock occurring from the use
of animal insulin.
2. Lipodystrophy – Hypertrophy or atrophy of subcutaneous tissue if the
same injection site is frequently used. Hypertrophy is a thickening of
subcutaneous tissue that can result in poor insulin absorption.
3. Somogyi effect – There is an undetected decrease in glucose levels during
the hours of sleep in response to too much insulin. Specific hormones are
released that produce a rebound hyperglycemia noticed in the morning
when glucose levels are measured. The danger exists when the insulin
dose is increased. The patient might complain of headache, night sweats,
or nightmares upon awakening. Patient glucose levels should be assessed
between 2 and 4 AM to determine if hypoglycemia is present. If so, the
insulin dosage affecting the early morning blood glucose is reduced.

4. Dawn phenomenon – Also characterized by hyperglycemia upon awaken- Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
ing due to the release of growth hormone (GH) and cortisol in the pre-
dawn hours. Treatment consists of increasing insulin dosage or the timing
of insulin administration. Blood glucose levels should be assessed at bed-
time, nighttime (between 2 and 4 AM), and morning fasting blood sugar.
If predawn levels are less than 60 mg/dL and signs of hypoglycemia are
present, the insulin dosage should be reduced. If the 2 and 4 AM blood
glucose is high, insulin dosage should be increased.

Hypoglycemia
Glucose levels drop below 50 to 70 mg/mL or lower from taking too much
insulin, eating late or skipping meals, and excessive unplanned exercise. Symp-
toms of hypoglycemia can occur quickly. They include pallor, confusion, slurred
speech, palpitation, tremor, diaphoresis, hunger, anxiety, numbness, and tingling
in extremities. Patients can even have seizures and lose consciousness. It is rec-
ommended that patients carry snacks or candy when out and about for a quick
glucose fix between meals.

Gestational Diabetes
May develop during pregnancy; however, mother’s condition returns to normal
post delivery. Trends show that 40% to 60% of these women will develop dia-
betes later in life.