A client newly diagnosed with diabetes mellitus takes NPH insulin at 7:00 am. The client should watch for late-afternoon signs of hypoglycemia. Which signs indicate this in the late afternoon?

A client newly diagnosed with diabetes mellitus takes NPH insulin at 7:00 am. The client should watch for late-afternoon signs of hypoglycemia. Which signs indicate this in the late afternoon?

• A. Nausea and vomiting, and abdominal pain
• B. Hunger; shakiness; and cool, clammy skin
• C. Drowsiness; red, dry skin; and fruity breath odor
• D. Increased urination; thirst; and rapid, deep breathing

Answer: (B)

When a person with diabetes uses insulin, late-afternoon hypoglycemia is a real risk because the insulin taken in the morning can still be actively lowering blood glucose during the afternoon. The earliest and most reliable warning signs are autonomic symptoms that reflect the body’s attempt to raise glucose: hunger, shakiness or trembling, and cool, clammy skin. These are classic, patient-friendly cues that low blood glucose is occurring and that a fast-acting carbohydrate is needed. Other signs listed don’t fit hypoglycemia as well. Nausea, vomiting, and abdominal pain aren’t typical early hypoglycemia cues and can point to other issues. Drowsiness can occur with hypoglycemia, but fruity breath and red, dry skin signal ketosis or high glucose states, not low glucose. Increased urination, thirst, and rapid, deep breathing are hallmark signs of hyperglycemia or a metabolic crisis like ketoacidosis, not hypoglycemia. So, the signs that best indicate late-afternoon hypoglycemia from morning NPH insulin are hunger, shakiness, and cool, clammy skin.

When a person with diabetes uses insulin, late-afternoon hypoglycemia is a real risk because the insulin taken in the morning can still be actively lowering blood glucose during the afternoon. The earliest and most reliable warning signs are autonomic symptoms that reflect the body’s attempt to raise glucose: hunger, shakiness or trembling, and cool, clammy skin. These are classic, patient-friendly cues that low blood glucose is occurring and that a fast-acting carbohydrate is needed.

Other signs listed don’t fit hypoglycemia as well. Nausea, vomiting, and abdominal pain aren’t typical early hypoglycemia cues and can point to other issues. Drowsiness can occur with hypoglycemia, but fruity breath and red, dry skin signal ketosis or high glucose states, not low glucose. Increased urination, thirst, and rapid, deep breathing are hallmark signs of hyperglycemia or a metabolic crisis like ketoacidosis, not hypoglycemia.

So, the signs that best indicate late-afternoon hypoglycemia from morning NPH insulin are hunger, shakiness, and cool, clammy skin.