Which condition would the nurse associate the response of diaphoresis, weakness, and pallor at 3:00 PM in a client with type 1 diabetes who receives 30 units of neutral protamine Hagedorn (NPH) insulin at 7:00 AM?

• A. Diabetic coma
• B. Hyperosmolar hyperglycemic nonketotic syndrome
• C. Diabetic ketoacidosis
• D. Hypoglycemic reaction

Answer: (D)

The main concept is recognizing insulin-induced hypoglycemia during the peak action period of morning insulin. NPH insulin given at 7:00 AM typically peaks several hours later, around the middle of the day to afternoon. By 3:00 PM, its glucose-lowering effect is near or at its peak, which makes low blood glucose likely. Diaphoresis (sweating), pallor, and weakness are classic signs of hypoglycemia as the brain and autonomic nerves respond to insufficient glucose. In contrast, states like diabetic ketoacidosis or hyperosmolar hyperglycemic nonketotic syndrome involve high blood glucose and dehydration, producing different symptoms (polyuria, polydipsia, weight loss, tachypnea, dehydration) rather than the autonomic signs of low blood sugar. Therefore, this presentation best fits a hypoglycemic reaction. If this were real, checking a finger-stick glucose and treating with fast-acting carbohydrate would be the next step.