# A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, sweating, and palpitations 30 minutes after the morning insulin dose. Bedside capillary blood glucose is 52 mg/dL. Which action should the nurse take FIRST?

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> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, sweating, and palpitations 30 minutes after the morning insulin dose. Bedside capillary blood glucose is 52 mg/dL. Which action should the nurse take FIRST?

## Option

1. Provide 15 g of fast-acting oral carbohydrate (such as 4 oz of fruit juice) and recheck the blood glucose in 15 minutes **✔ Correct answer**
2. Notify the primary care provider immediately, document the event, and continue to monitor the client's vital signs
3. Administer 1 mg of glucagon subcutaneously, then recheck the blood glucose in 15 minutes and notify the provider
4. Withhold the next regularly scheduled meal until the blood glucose normalizes to prevent rebound hyperglycemia

**Correct answer: 1**

## Explanation

The Rule of 15 (15 g of fast-acting oral carbohydrate followed by a blood glucose recheck in 15 minutes) is the first-line treatment for symptomatic but conscious hypoglycemia in an alert adult who can swallow. Glucagon is reserved for clients who are unconscious, seizing, or unable to take oral intake. Notifying the provider is appropriate after stabilization, not as the first action. Withholding food worsens hypoglycemia and is contrary to recommended care.

## In-depth explanation

Clinical Judgment
The cue is a conscious adult with neuroglycopenic and adrenergic symptoms plus BG 52 mg/dL. Recognize cues -> mild-to-moderate hypoglycemia in an alert client who can swallow. Analyze cues -> ADA Standards of Care: oral glucose first when alert. Take action -> apply the Rule of 15.

Memory Tip
"15-15 Rule": 15 g carbs, recheck in 15 minutes. If still

## Clinical scenario

Clinical Practice Guide
ADA Rule of 15 for conscious symptomatic hypoglycemia (

## Key concepts

- **Hypoglycemia** — Blood glucose
- **Rule of 15** — ADA-recommended sequence for treating conscious mild-to-moderate hypoglycemia: 15 g of fast-acting oral carbohydrate -> recheck blood glucose in 15 minutes -> repeat if still
- **Glucagon** — A pancreatic alpha-cell hormone given IM or SC (1 mg) for severe hypoglycemia when the client cannot take oral intake. Mobilizes hepatic glycogen to raise blood glucose. Common adverse effects include nausea and vomiting; place the client in a lateral recovery position.

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