Adrenergic: shakiness, diaphoresis, tachycardia, hunger, anxiety
Before you read
Test yourself first: 5 questions
Question 1 of 5
A home care nurse is teaching a client newly diagnosed with type 2 diabetes about recognizing hypoglycemia. Which symptom should the nurse include?
Answer: B. Hypoglycemia produces sympathetic symptoms such as shakiness, sweating, palpitations, and confusion. Polyuria, increased thirst, and warm dry skin are signs of hyperglycemia, not hypoglycemia.
Question 2 of 5
A laboring client with gestational diabetes has her blood glucose monitored closely during labor. Which intrapartum glucose range is generally targeted to reduce neonatal hypoglycemia?
Answer: A. Maintaining maternal blood glucose roughly between 70 and 110 mg/dL during labor helps prevent fetal hyperinsulinemia and subsequent neonatal hypoglycemia after birth. Persistently high intrapartum glucose increases the neonate's risk of rebound hypoglycemia.
Question 3 of 5
A nurse cares for a client who became hypoglycemic during the night. Which mechanism explains the Somogyi effect?
Answer: A. The Somogyi effect is rebound morning hyperglycemia that follows nocturnal hypoglycemia. The hypoglycemia triggers release of counterregulatory hormones (glucagon, epinephrine, cortisol), which raise blood glucose by morning. It is managed by reducing the evening insulin or adding a bedtime snack, not by increasing insulin.
Question 4 of 5
An older adult with type 2 diabetes is at risk for hypoglycemia. Which presentation may differ in older adults compared with younger patients?
Answer: A. Older adults may have blunted or atypical hypoglycemia symptoms, presenting with confusion or behavioral changes rather than the classic adrenergic signs like tremor and sweating, which can delay recognition. The classic symptoms are not always exaggerated or absent in a predictable way; the key point is the atypical, neuroglycopenic presentation.
Question 5 of 5
A client reports waking with high fasting blood glucose levels. The nurse explains the Somogyi effect. Which description is accurate?
Answer: B. In the Somogyi effect, an episode of nocturnal hypoglycemia (often around 0200 to 0300) triggers counterregulatory hormone release, causing rebound morning hyperglycemia. Management may involve reducing the evening insulin dose or adding a bedtime snack. The dawn phenomenon, by contrast, is morning hyperglycemia from a natural early-morning surge in hormones without preceding hypoglycemia.
Keep the streak going with more questions like these, each with a full rationale.
What is hypoglycemia?
The brain depends on glucose, so symptoms come on fast and are an emergency. A level below 54 mg/dL is clinically significant, and any low glucose with confusion or inability to self-treat is severe hypoglycemia. Causes include too much insulin, skipped meals and extra exercise.
Key points to remember
- Adrenergic: shakiness, diaphoresis, tachycardia, hunger, anxiety
- Neuroglycopenic: confusion, slurred speech, blurred vision, seizures, coma
- Onset is rapid (vs the gradual onset of hyperglycemia)
- Common triggers: an insulin or sulfonylurea dose that is too high, a late or missed meal, vomiting, extra exercise, alcohol, and worsening kidney function.
- Beta blockers can hide the tremor and fast heart rate; sweating usually still occurs.
- Low glucose during the night may show as nightmares, night sweats or a morning headache.
Common causes
- Too much insulin, skipped meal
- Excess exercise, alcohol
Signs & symptoms
- Shaky, sweaty, tachycardic
- Confusion, irritable, slurred
- Seizure, coma if severe
Nursing priorities
- If conscious: give 15 g fast-acting carbohydrate (4 oz juice, glucose tabs), recheck in 15 min
- Repeat the 15/15 rule until glucose > 70, then give a complex carb + protein snack
- If unconscious or NPO: IV dextrose 50% (D50) or IM/SubQ glucagon
- Check glucose before meals and before giving insulin; hold the dose and notify the provider if it is low.
- Once the patient is alert and can swallow, give a snack with carbohydrate and protein, then find and correct the cause.
Labs & values
Patient teaching
- Always carry a fast sugar source; treat early symptoms immediately
- Recognize that beta blockers can mask the early shaky/tachycardic warning signs
- Teach family members to give glucagon (injection or nasal) if the person cannot swallow.
- Check glucose before driving and treat a low reading, then recheck, before getting behind the wheel.
Red flags: report now
- Unconscious, seizing, or unable to swallow — do NOT give oral food/fluids; use IV D50 or glucagon
- A glucose below 54 mg/dL, or any confusion, seizure or loss of consciousness, needs immediate treatment.
References
Clinical references for this topic
