# A nurse is teaching a 55-year-old client with newly diagnosed type 2 diabetes who started insulin glargine 10 units at bedtime this week. The provider will adjust the glargine dose from the client's home glucose log. The client peels an orange at breakfast, then wipes a finger with an alcohol pad and checks the glucose. The client works outdoors and prefers forearm testing because it hurts less. Yesterday at work the client felt shaky and sweaty, had left the meter at home, and waited until getting home to eat. Which instructions should the nurse include? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=617289&lang=en  
> language: en  
> subject: Self-Care  
> category: HPM

## Question

A nurse is teaching a 55-year-old client with newly diagnosed type 2 diabetes who started insulin glargine 10 units at bedtime this week. The provider will adjust the glargine dose from the client's home glucose log. The client peels an orange at breakfast, then wipes a finger with an alcohol pad and checks the glucose. The client works outdoors and prefers forearm testing because it hurts less. Yesterday at work the client felt shaky and sweaty, had left the meter at home, and waited until getting home to eat. Which instructions should the nurse include? Select all that apply.

1

Check the glucose on waking, before eating, because that value guides the glargine dose

2

Wipe away the first drop and test the second drop instead of washing after peeling fruit

3

Check the glucose 2 hours after breakfast, because that value guides the glargine dose

4

Take 15 g of fast carbohydrate right away when shaky at work and no meter is available

5

Use the forearm for checks when shaky, since the site hurts less and needs less blood

6

Wash with soap and water and dry the hands before testing on days you have peeled fruit

## Explanation

Bedtime basal insulin is titrated from the fasting value, not a postprandial one. After handling fruit, sugar on the skin can falsely raise both the first and the second drop, so hands must be washed and dried rather than relying on wiping away a drop. Forearm (alternate-site) results lag behind fingertip values when glucose is changing, so they are not used when hypoglycemia is suspected; if symptoms occur and no meter is available, the client treats with 15 g of fast carbohydrate right away instead of waiting.

## In-depth explanation

Quick answer
Teach fasting checks for glargine, hand washing after fruit, and immediate treatment of symptoms when no meter is available.

Why this is correct
Each key depends on a detail of this client. Bedtime glargine is adjusted to the fasting value, while 2-hour postprandial checks guide mealtime insulin. Peeling fruit leaves enough sugar on the fingers that even the second drop can read falsely high, so washing and drying are required. Because the client once waited hours with symptoms and no meter, the teaching is to treat right away with 15 g of fast carbohydrate and confirm with a check as soon as possible.

Easy analogy or mental picture
Think of the fasting value as the overnight report card for the bedtime insulin; a post-breakfast value grades breakfast, not the bedtime shot.

Memory hook
Basal = before breakfast. Fruit on fingers = soap, not second drop. Shaky and no meter = treat now.

NCLEX decision rule
Match the timing and site of the glucose check to the decision being made, and never delay treating suspected hypoglycemia for lack of a meter.

Why the other choices are wrong
Wiping away the first drop is a real technique when hands cannot be washed, which makes it tempting, but after handling fruit the second drop can still be contaminated. Checking 2 hours after breakfast is taught for postprandial targets, yet it reflects the meal and would lead to wrong glargine changes. Forearm testing is an approved alternate site and does hurt less, but its readings lag when glucose is falling, so it can miss a low exactly when the client feels shaky.

References
1ADA Standards of Care in Diabetes—2025 (Diabetes Care Supplement 1)Glucose monitoring, basal insulin titration using fasting glucose, and hypoglycemia recognition and treatment thresholds
2CDC — DiabetesPatient education on checking blood sugar and managing low blood sugar

## Clinical scenario

Scenario
55-year-old newly diagnosed with type 2 diabetes, started bedtime insulin glargine this week; dose titration depends on the home log. Handles fruit before testing, prefers forearm testing, and delayed treatment of shakiness when the meter was unavailable.

## Key concepts

- **Fasting glucose** — A capillary glucose taken after at least 8 hours without food, used to titrate basal insulin such as glargine.
- **Alternate-site testing** — Glucose testing on the forearm or palm, which lags behind fingertip values when glucose is changing rapidly.
- **Level 1 hypoglycemia** — A glucose value below 70 mg/dL but at or above 54 mg/dL, treated with 15 g of fast carbohydrate and a recheck in 15 minutes.

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