# A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking propranolol 80 mg orally twice daily and glipizide 10 mg orally daily. The client tells the nurse, "Lately I have not been able to tell when my blood sugar drops; I just suddenly start sweating heavily." Which response by the nurse is most appropriate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking propranolol 80 mg orally twice daily and glipizide 10 mg orally daily. The client tells the nurse, "Lately I have not been able to tell when my blood sugar drops; I just suddenly start sweating heavily." Which response by the nurse is most appropriate?

## Option

1. "Propranolol blocks many of the warning signs of hypoglycemia, but diaphoresis remains — check your glucose immediately when you sweat unexpectedly." **✔ Correct answer**
2. "You could hold the propranolol when you experience these sweating spells, as the drug itself can cause diaphoresis, and then resume the following day."
3. "Tachycardia and tremor often remain as reliable indicators despite propranolol; you should check your heart rate between meals to catch low glucose."
4. "That suggests your glucose control is stabilizing, and isolated sweating is not typically a symptom of hypoglycemia you should worry about."

**Correct answer: 1**

## Explanation

Beta-blocker masking of hypoglycemia
Non-selective beta-blockers (e.g., propranolol) and high-dose cardioselective agents block beta1- and beta2-mediated sympathetic responses, masking the classic hypoglycemia warning signs — tachycardia, tremor, palpitations, and anxiety. Diaphoresis is cholinergically mediated and persists, becoming the most reliable autonomic cue. Patients on a beta-blocker plus a sulfonylurea (glipizide) or insulin must be taught to check blood glucose immediately whenever unexpected sweating, hunger, confusion, or weakness occurs, and to keep fast-acting carbohydrate accessible. Stopping propranolol abruptly can precipitate rebound HTN, MI, and migraine breakthrough — never instruct self-discontinuation. The hypoglycemia symptom change is not "improvement"; it reflects pharmacologic blockade.

## In-depth explanation

Why option 2 is correct
Nonselective beta-blockers such as propranolol, and high-dose cardioselective beta-blockers, block beta1 and beta2 sympathetic responses. This can mask classic hypoglycemia warnings such as tachycardia, tremor, palpitations, and anxiety. Sweating is cholinergically mediated, so it may persist and become the most reliable autonomic cue. A client taking a beta-blocker plus glipizide or insulin should check glucose immediately for unexpected sweating, hunger, confusion, or weakness and keep fast-acting carbohydrate available.

Distractor review
Option 1: tachycardia and tremor are the exact symptoms propranolol may hide. Option 3: sweating alone does not mean diabetes has improved; it reflects altered warning signs. Option 4: abrupt propranolol discontinuation can cause rebound hypertension, MI, and migraine recurrence. The prescriber should decide dose changes or alternatives.

Nursing focus
Diabetes plus a beta-blocker means sweating, drowsiness, poor concentration, blurred vision, or weakness can be hypoglycemia clues. Reinforce self-monitoring, glucose tablets, and home glucagon when appropriate.

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