# Situation: The public health nurse makes follow-up home visits to adults enrolled in the barangay registry for hypertension and diabetes. A 62-year-old woman with type 2 diabetes who takes gliclazide feels shaky and sweaty before lunch. Her capillary blood glucose is 58 mg/dL (3.2 mmol/L). She is alert and able to swallow. What should the nurse do FIRST?

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> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The public health nurse makes follow-up home visits to adults enrolled in the barangay registry for hypertension and diabetes.

A 62-year-old woman with type 2 diabetes who takes gliclazide feels shaky and sweaty before lunch. Her capillary blood glucose is 58 mg/dL (3.2 mmol/L). She is alert and able to swallow. What should the nurse do FIRST?

## 보기

1. Serve her lunch of rice and fish right away
2. Give a chocolate bar and recheck in 30 minutes
3. Arrange a transfer for intravenous dextrose now
4. Give 120 mL of fruit juice and recheck in 15 minutes **✔ 정답**

**정답: 4**

## 해설

A glucose below 70 mg/dL (3.9 mmol/L) with symptoms is hypoglycemia, a known risk of sulfonylureas such as gliclazide. A conscious client who can swallow receives 15 g of fast-acting carbohydrate, such as 120 mL of juice, with a recheck in 15 minutes, repeated if still low, and then a snack or meal.

## 심화 해설

Clinical situation A 62-year-old woman on gliclazide presents with adrenergic symptoms—shakiness and sweating—before lunch. Capillary glucose is 58 mg/dL (3.2 mmol/L), which is below the 70 mg/dL (3.9 mmol/L) threshold that defines clinically important hypoglycemia [1][4]. She is alert and able to swallow, so the priority is rapid oral correction with a measured dose of fast-acting carbohydrate.

Why gliclazide causes this Gliclazide is a sulfonylurea that stimulates pancreatic beta cells to release insulin regardless of the current glucose level. When a meal is delayed—such as the period just before lunch—the drug’s insulin-releasing effect continues while exogenous glucose supply is low, producing a mismatch that drives glucose down. Hypoglycemia is a predictable, dose-related adverse effect of sulfonylureas, not an idiosyncratic reaction. The autonomic symptoms of sweating, tremor, and shakiness reflect counter-regulatory epinephrine release as the body attempts to raise glucose [2].

Rule of 15 for the conscious patient The standard first-line intervention for a conscious individual who can protect the airway is 15 grams of fast-acting carbohydrate, followed by a recheck in 15 minutes [1][4]. 120 mL of fruit juice provides approximately 15 g of simple carbohydrate in a rapidly absorbable liquid form, making it an ideal choice. If the repeat glucose remains below 70 mg/dL, the dose is repeated; once normalized, a snack or the next meal is given to prevent recurrence [1].

| Option | Rationale | Problem |
| --- | --- | --- |
| 1. Serve lunch now | Rice and fish provide complex carbohydrate and protein | Absorption is slower than simple sugar; does not rapidly correct acute neuroglycopenia |
| 2. Chocolate bar | Contains sugar | Fat in chocolate delays gastric emptying and slows glucose absorption; not first-line for urgent correction |
| 3. IV dextrose now | Rapid glucose delivery | Reserved for unconscious, NPO, or severely impaired patients; oral route is preferred when swallowing is intact [2][4] |
| 4. 120 mL juice + recheck in 15 min | Delivers ~15 g fast-acting carbohydrate; reassesses response | Correct first action for alert, swallowing patient |

Watch out! Do not give a full meal as the initial treatment. Complex carbohydrates and fat slow absorption, delaying recovery from hypoglycemia. The meal or snack comes *after* the fast-acting carbohydrate has raised glucose and a recheck confirms improvement [1][2].

Key point! The sequence is: give 15 g fast-acting carbohydrate, wait 15 minutes, recheck glucose, repeat if still below 70 mg/dL, then provide a snack or meal. Intravenous dextrose is only indicated when the patient cannot swallow safely or is unconscious [4].References (research sources)

- [1]6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026.Research articleAmerican Diabetes Association Professional Practice Committee for Diabetes*
. (2026) · DOI: 10.2337/dc26-s006

- [2]Hypoglycemia: Essential Clinical GuidelinesGuidelineThenmozhi Paluchamy (2019) · DOI: 10.5772/intechopen.86994

- [4]Hypoglycemia: Updates on Diagnosis and TreatmentResearch articleDinda Aprilia (2025) · DOI: 10.25077/jikesi.v6i1.1497

## 임상 시나리오

Hypoglycemia in Sulfonylurea-Treated DiabetesRule of 15 for the Alert Patient
A glucose below 70 mg/dL (3.9 mmol/L) with symptoms is hypoglycemia. In a conscious patient who can swallow, give 15 g of fast-acting carbohydrate such as 120 mL fruit juice, then recheck in 15 minutes.

Gliclazide is a sulfonylurea that stimulates insulin release regardless of glucose level. When a meal is delayed, the mismatch between ongoing insulin effect and low glucose supply can precipitate hypoglycemia.

CautionAvoid chocolate or mixed meals for initial correction because fat slows absorption. If glucose remains below 70 mg/dL after 15 minutes, repeat the 15 g carbohydrate dose. Once normalized, give a snack or meal to prevent recurrence.

## 핵심 개념

- **Hypoglycemia** — Blood glucose below 70 mg/dL (3.9 mmol/L) with or without symptoms, requiring prompt correction.
- **Rule of 15** — Give 15 grams of fast-acting carbohydrate, recheck glucose in 15 minutes, and repeat if still low.
- **Sulfonylurea** — A class of oral antidiabetic drugs, including gliclazide, that stimulate insulin release and can cause hypoglycemia.
- **Fast-acting carbohydrate** — Simple sugars such as 120 mL fruit juice or glucose tablets that rapidly raise blood glucose.
- **Counter-regulatory response** — Release of hormones like epinephrine that produce adrenergic symptoms such as sweating and shakiness during hypoglycemia.

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