A client with type 1 diabetes mellitus takes NPH insulin every morning and checks the blood glucose level four times per day. The client tells the nurse that yesterday the late afternoon blood glucose was 60 mg/dL and that she 'felt funny.' Which statement by the client indicates an understanding of this occurrence?

A client with type 1 diabetes mellitus takes NPH insulin every morning and checks the blood glucose level four times per day. The client tells the nurse that yesterday the late afternoon blood glucose was 60 mg/dL and that she 'felt funny.' Which statement by the client indicates an understanding of this occurrence?

• A. "I forgot to take my usual mid-afternoon snack yesterday."
• B. "I took less insulin this morning, so I won't feel funny today."
• C. "My blood glucose levels are running low because I'm tired."
• D. "I don't know why I have to check my blood glucose four times a day. That seems too much."

Answer: (A)

The main idea is that hypoglycemia can occur when insulin action peaks in the afternoon while carbohydrate intake is reduced. NPH insulin, given in the morning, has a peak several hours later, typically in the late afternoon to evening. If the person skips a planned snack in that period, there’s less glucose entering the bloodstream to balance the insulin that’s still active. The result can be a blood glucose level as low as 60 mg/dL with symptoms like feeling funny, dizziness, or shakiness. So the statement about forgetting the mid‑afternoon snack demonstrates understanding of this cause-and-effect: missing a planned carbohydrate source when insulin is peaking can lead to hypoglycemia. The other options don’t explain the event as well—reducing insulin would not reliably cause this late‑afternoon drop, fatigue is a nonspecific symptom and doesn’t explain the mechanism, and questioning why to check glucose doesn’t address why the hypoglycemia occurred.

The main idea is that hypoglycemia can occur when insulin action peaks in the afternoon while carbohydrate intake is reduced. NPH insulin, given in the morning, has a peak several hours later, typically in the late afternoon to evening. If the person skips a planned snack in that period, there’s less glucose entering the bloodstream to balance the insulin that’s still active. The result can be a blood glucose level as low as 60 mg/dL with symptoms like feeling funny, dizziness, or shakiness.

So the statement about forgetting the mid‑afternoon snack demonstrates understanding of this cause-and-effect: missing a planned carbohydrate source when insulin is peaking can lead to hypoglycemia. The other options don’t explain the event as well—reducing insulin would not reliably cause this late‑afternoon drop, fatigue is a nonspecific symptom and doesn’t explain the mechanism, and questioning why to check glucose doesn’t address why the hypoglycemia occurred.