Symptomatic hypoglycemia is most likely to develop if a patient

• A. overeating and missing an insulin dose
• B. misses one or two prescribed insulin injections
• C. eats a regular meal followed by mild exertion
• D. takes too much prescribed insulin

Answer: (D)

Insulin lowers blood glucose by promoting uptake into muscle and fat and by suppressing glucose production in the liver. Hypoglycemia happens when insulin action exceeds the available glucose. Taking too much prescribed insulin creates more insulin activity than the body's glucose supply can support, so blood glucose drops rapidly and symptoms of hypoglycemia appear.

The other scenarios don’t produce the same mismatch between insulin and glucose. Overeating while skipping insulin raises blood glucose rather than lowering it. Missing one or two injections tends to raise glucose levels as well. Eating a regular meal followed by mild exertion provides ongoing glucose and only modestly increases glucose uptake with activity, which is less likely to cause symptomatic hypoglycemia than an excess of insulin.