# Situation: A 67-year-old woman who has had type 2 diabetes mellitus for 15 years attends the medical clinic. She takes metformin, glipizide, and acarbose for diabetes and metoprolol for hypertension. Monofilament testing shows loss of protective sensation in both feet. Her capillary glucose is 58 mg/dL (3.2 mmol/L). She is awake, alert, and able to swallow. The unit protocol calls for 15 g of fast-acting carbohydrate, given as the fewest whole units that provide at least 15 g. Each glucose tablet contains 4 g of glucose, and each teaspoon of table sugar contains 4 g of sucrose. What should the nurse give?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630402  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 67-year-old woman who has had type 2 diabetes mellitus for 15 years attends the medical clinic. She takes metformin, glipizide, and acarbose for diabetes and metoprolol for hypertension. Monofilament testing shows loss of protective sensation in both feet.

Her capillary glucose is 58 mg/dL (3.2 mmol/L). She is awake, alert, and able to swallow. The unit protocol calls for 15 g of fast-acting carbohydrate, given as the fewest whole units that provide at least 15 g. Each glucose tablet contains 4 g of glucose, and each teaspoon of table sugar contains 4 g of sucrose. What should the nurse give?

## 보기

1. Four glucose tablets **✔ 정답**
2. Two glucose tablets
3. Eight glucose tablets
4. Four teaspoons of table sugar in water

**정답: 1**

## 해설

She can swallow, so the Rule of 15 applies: 15 g of fast-acting carbohydrate, then a recheck in 15 minutes. Because acarbose blocks the breakdown of sucrose and starch in the gut, the carbohydrate must be glucose itself. At 4 g per tablet, 15 ÷ 4 = 3.75, so four tablets (16 g) are the fewest that reach 15 g.

## 심화 해설

What the nurse should give
Her capillary glucose is 58 mg/dL (3.2 mmol/L), and she is awake, alert, and able to swallow, so oral treatment is appropriate. Because she takes acarbose, which blocks the breakdown of sucrose and starch in the gut, the carbohydrate must be glucose itself. At 4 g per tablet, 15 ÷ 4 = 3.75, so four glucose tablets (16 g) are the fewest whole units that reach at least 15 g.

The Rule of 15 and the acarbose exception
The Rule of 15 guides treatment of mild to moderate hypoglycemia in a client who can swallow: give 15 g of fast-acting carbohydrate, recheck glucose in 15 minutes, and repeat if the level remains low. Once glucose recovers, a snack or meal follows to prevent recurrence. Most fast-acting carbohydrates, such as table sugar, juice, or regular soft drinks, contain sucrose or other sugars. Acarbose is an alpha-glucosidase inhibitor; it slows the conversion of sucrose and starch into absorbable glucose, so these sources raise blood glucose too slowly. Pure glucose needs no digestion and is absorbed directly.

| Option | Carbohydrate | Problem |
| --- | --- | --- |
| Four glucose tablets | 16 g glucose | Correct: fewest units reaching 15 g; absorbed despite acarbose |
| Two glucose tablets | 8 g glucose | About half the required amount |
| Eight glucose tablets | 32 g glucose | About twice the protocol amount; risks rebound hyperglycemia |
| Four teaspoons of sugar | 16 g sucrose | Enough amount, but acarbose blocks its breakdown |

Why the distractors are wrong
Two tablets provide too little, and the hypoglycemia may persist. Eight tablets overshoot the protocol and may cause rebound hyperglycemia. Four teaspoons of table sugar supply the right amount, but the form is wrong for a client on acarbose, which is the trap in this item.

Nursing application
The nurse gives four glucose tablets, rechecks capillary glucose in 15 minutes, repeats treatment if still low, and offers a snack once glucose has recovered. Because glipizide has a long duration of action, the nurse continues monitoring and reports the episode so her regimen can be reviewed. She is taught to keep glucose tablets or gel, not candy or sugar, for treating lows.

Exam takeaway
Watch out A client on acarbose must treat hypoglycemia with glucose, not sucrose. In dose questions, calculate the fewest whole units that meet the minimum amount.

## 임상 시나리오

Treating Hypoglycemia on AcarboseThe Rule of 15 with the right sugar
She can swallow, so the Rule of 15 applies: 15 g of fast-acting carbohydrate, then a recheck in 15 minutes.

Acarbose blocks breakdown of sucrose and starch, so treatment must be glucose. At 4 g per tablet, 15 ÷ 4 = 3.75, so four tablets (16 g) are given.

CautionTable sugar, juice, and candy act too slowly in a client on acarbose. Teach her to keep glucose tablets or gel for treating lows.

## 핵심 개념

- **Rule of 15** — Give 15 g of fast-acting carbohydrate, recheck glucose in 15 minutes, and repeat if still low.
- **Acarbose** — An alpha-glucosidase inhibitor that slows digestion of sucrose and starch in the intestine.
- **Glucose tablet** — A chewable tablet of pure glucose that is absorbed without digestion.
- **Sucrose** — Table sugar, a disaccharide that must be broken down into glucose and fructose before absorption.

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