Hypoglycemia Practice Questions

25 multiple-choice questions on Hypoglycemia for paramedic and EMT students, from Chapter 24 (Endocrine Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Under ADA definitions, level 3 (severe) hypoglycemia is defined by:

   1. A. Any glucose below 100 mg/dL
   2. B. Needing help from another person
   3. C. A glucose below 70 with no symptoms
   4. D. Sweating after exercise
   Show answer

   Answer: B. Needing help from another person

   Level 1 is below 70 mg/dL, level 2 is below 54 mg/dL, and level 3 is any event with altered mental or physical status requiring assistance to treat, regardless of the number.

2. The most common cause of hypoglycemia in diabetics is:

   1. A. Insulin without enough food
   2. B. Missing a dose of insulin
   3. C. Missing a dose of metformin
   4. D. Eating too many carbohydrates
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   Answer: A. Insulin without enough food

   Taking insulin or a sulfonylurea and then skipping a meal, vomiting, or exercising more than usual drops glucose. Missing insulin or eating extra carbohydrate raises glucose, and metformin rarely causes lows.

3. For an alert hypoglycemic adult who can swallow, current guidance is to give about:

   1. A. 2 g of glucose, then let her sleep
   2. B. 100 g of glucose at one time
   3. C. A protein shake by itself
   4. D. 15 to 20 g glucose, then recheck
   Show answer

   Answer: D. 15 to 20 g glucose, then recheck

   The ADA recommends 15 to 20 g of fast-acting glucose, rechecking in about 15 minutes and repeating if still low, then a meal or snack. Protein alone raises glucose too slowly.

4. Neuroglycopenic signs of hypoglycemia include:

   1. A. Confusion, slurred speech
   2. B. Fruity breath and intense thirst
   3. C. Warm, dry, flushed skin
   4. D. Deep, rapid breathing
   Show answer

   Answer: A. Confusion, slurred speech

   When the brain lacks glucose, patients become confused, combative, or drowsy. They can be mistaken for intoxicated or having a stroke.

5. Insulin pens should never be shared between patients, even with a new needle, because:

   1. A. Insulin loses strength when shared
   2. B. Pens hold only one dose
   3. C. Blood can flow back into the pen
   4. D. Shared pens give double doses
   Show answer

   Answer: C. Blood can flow back into the pen

   Blood can back up into the cartridge, so sharing pens can spread hepatitis B, hepatitis C, and HIV. The CDC states that pens are for single-patient use only.

6. A type 1 diabetic with frequent lows no longer feels shaky or sweaty before becoming confused. This is called:

   1. A. Insulin resistance
   2. B. Hypoglycemia unawareness
   3. C. Diabetic ketoacidosis
   4. D. The dawn phenomenon each day
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   Answer: B. Hypoglycemia unawareness

   Repeated hypoglycemia blunts the adrenaline response, so warning symptoms disappear and the first sign may be confusion or seizure. Avoiding lows for a few weeks can restore awareness.

7. A conscious hypoglycemic patient who can swallow and protect the airway should receive:

   1. A. Oral glucose
   2. B. IV dextrose only
   3. C. IM glucagon only
   4. D. Nothing until arrival
   Show answer

   Answer: A. Oral glucose

   Oral glucose gel or tablets work well if the patient is alert enough to swallow safely. Follow with complex carbohydrates.

8. Which choice raises blood glucose most slowly in an alert hypoglycemic patient?

   1. A. Orange juice
   2. B. Glucose tablets
   3. C. A chocolate bar
   4. D. Regular soda
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   Answer: C. A chocolate bar

   Fat in chocolate slows stomach emptying and glucose absorption, so it is a poor first choice. Glucose tablets, juice, or regular (not diet) soda act faster.

9. Years after gastric bypass, a nondiabetic has sweating, confusion, and a glucose of 48 mg/dL about 2 hours after meals. This is most likely:

   1. A. Early type 1 diabetes
   2. B. Post-bypass hypoglycemia
   3. C. A stroke
   4. D. An alcohol withdrawal seizure
   Show answer

   Answer: B. Post-bypass hypoglycemia

   After bypass, rapid nutrient delivery triggers an exaggerated insulin surge 1 to 3 hours after eating (late dumping or post-bariatric hypoglycemia). Treat the low and report the surgical history.

10. Repeated fasting hypoglycemia in a healthy adult who takes no diabetes medicine may be caused by:

    1. A. Early-stage type 2 diabetes
    2. B. Eating too much sugar
    3. C. Insulin resistance
    4. D. An insulin-secreting tumor
    Show answer

    Answer: D. An insulin-secreting tumor

    An insulinoma, a pancreatic tumor that secretes insulin, causes recurrent fasting hypoglycemia with symptoms relieved by eating. Other causes include sepsis, liver failure, and surreptitious insulin or sulfonylurea use. Early type 2 diabetes and insulin resistance raise fasting glucose rather than lowering it, and a sugary diet does not cause fasting lows.

11. A child with no diabetes has repeated severe lows, and the parent has access to insulin at work. You should consider:

    1. A. Normal childhood growth
    2. B. Medical child abuse
    3. C. Food allergy
    4. D. Too much exercise at school
    Show answer

    Answer: B. Medical child abuse

    Unexplained recurrent hypoglycemia in a nondiabetic child can be caused by caregiver-administered insulin or sulfonylureas (medical child abuse). Treat the low, document objectively, and report per law.

12. An older diabetic on glipizide develops severe hypoglycemia after starting a new antibiotic. Which antibiotic class carries an FDA warning for this?

    1. A. Penicillins
    2. B. Macrolides
    3. C. Topical antifungals
    4. D. Fluoroquinolones
    Show answer

    Answer: D. Fluoroquinolones

    In 2018 the FDA strengthened warnings that fluoroquinolones such as ciprofloxacin and levofloxacin can cause serious hypoglycemia, especially in older adults on diabetes drugs. Ask about recent medication changes.

13. Severe hypoglycemia can be especially dangerous in patients with heart disease because it can:

    1. A. Trigger dangerous heart rhythms
    2. B. Cause pericardial effusion
    3. C. Thin the blood and cause bleeding
    4. D. Lower the heart rate to normal
    Show answer

    Answer: A. Trigger dangerous heart rhythms

    Hypoglycemia triggers adrenaline release and prolongs the QT interval, which can cause ischemia and ventricular dysrhythmias. Place a monitor on patients with severe lows. It does not cause pericardial fluid or thin the blood.

14. A patient with insulin-only hypoglycemia who fully recovers may be released per protocol if:

    1. A. They refuse to eat anything afterward
    2. B. They live alone and are still confused
    3. C. An adult stays with them and they can eat
    4. D. They also take a sulfonylurea
    Show answer

    Answer: C. An adult stays with them and they can eat

    Treat-and-release criteria usually require a normal repeat glucose, a known cause, ability to eat, and a responsible adult present. Follow local protocol.

15. A 4-year-old drank alcohol from an unattended glass and is now drowsy. You should check:

    1. A. Serum ketones
    2. B. Blood glucose
    3. C. Peak flow
    4. D. Visual acuity
    Show answer

    Answer: B. Blood glucose

    Alcohol blocks gluconeogenesis, and children have small glycogen stores, so hypoglycemia is common after alcohol ingestion.

16. Which morning report suggests a diabetic patient had low blood sugar during the night?

    1. A. Waking very thirsty
    2. B. A fruity breath odor on waking up
    3. C. Night sweats and nightmares
    4. D. Itchy skin on the arms
    Show answer

    Answer: C. Night sweats and nightmares

    Nocturnal hypoglycemia often causes sweating, restless sleep or nightmares, and a morning headache or confusion. It is common with evening insulin, alcohol, or exercise. Thirst and a fruity odor suggest high glucose overnight, not low.

17. Used alone, which diabetes medicine is least likely to cause hypoglycemia?

    1. A. Metformin
    2. B. Glyburide
    3. C. Insulin
    4. D. Glipizide
    Show answer

    Answer: A. Metformin

    Metformin lowers liver glucose output without stimulating insulin release, so it rarely causes hypoglycemia on its own. Insulin and sulfonylureas (glyburide, glipizide) commonly do.

18. Shortly after birth, the baby of a mother with poorly controlled diabetes is jittery. The most likely cause is:

    1. A. High glucose from the mother
    2. B. Low oxygen from the umbilical cord
    3. C. Normal reflexes of a newborn
    4. D. Low glucose from its own insulin
    Show answer

    Answer: D. Low glucose from its own insulin

    High maternal glucose crosses the placenta and the fetus makes extra insulin. After the cord is cut, the glucose supply stops but insulin stays high, causing neonatal hypoglycemia.

19. Sugar residue on a patient's fingertip can make a glucose reading:

    1. A. Falsely low
    2. B. Exactly correct
    3. C. Read as an error
    4. D. Falsely high
    Show answer

    Answer: D. Falsely high

    Glucose from food, juice, or a glucose gel on the skin contaminates the sample and can mask hypoglycemia. Clean and dry the site before testing.

20. Hypoglycemia in a non-diabetic adult should raise suspicion of:

    1. A. Sepsis, liver failure, ingestion
    2. B. A normal overnight fast
    3. C. Heavy exercise the day before the call
    4. D. Mild dehydration from heat
    Show answer

    Answer: A. Sepsis, liver failure, ingestion

    Severe illness, liver failure, adrenal insufficiency, and ingestions (such as a family member's sulfonylurea) can cause hypoglycemia.

21. Women with type 1 diabetes are especially prone to severe hypoglycemia during:

    1. A. The week before a period
    2. B. Early pregnancy
    3. C. Menopause only
    4. D. Breast development
    Show answer

    Answer: B. Early pregnancy

    Insulin sensitivity rises and nausea reduces intake in the first trimester, so severe hypoglycemia is most common early in pregnancy for women with type 1 diabetes.

22. Which finding helps distinguish hypoglycemia from DKA in an unresponsive diabetic?

    1. A. Fruity breath odor
    2. B. Deep, rapid breathing
    3. C. Cool, clammy skin
    4. D. Severe dehydration
    Show answer

    Answer: C. Cool, clammy skin

    Hypoglycemia causes pale, sweaty skin. DKA causes warm, dry skin, Kussmaul respirations, and fruity breath. The glucometer settles it.

23. After dextrose, a patient's glucose rises to 140 mg/dL but he remains unresponsive. You should:

    1. A. Look for another cause
    2. B. Give more dextrose
    3. C. Assume he is simply sleeping
    4. D. Give insulin
    Show answer

    Answer: A. Look for another cause

    If mental status does not improve with normal glucose, consider stroke, head injury, overdose, seizure, or sepsis.

24. Older adults with hypoglycemia more often show:

    1. A. Sweating more than confusion
    2. B. Tremor more than confusion
    3. C. Confusion more than sweating
    4. D. Very high blood pressure
    Show answer

    Answer: C. Confusion more than sweating

    Adrenergic warning signs are blunted with age, so older adults more often present with neuroglycopenic signs such as confusion, dizziness, falls, or focal deficits. Check glucose in any older adult with a change in behavior. Sweating and tremor are the adrenergic signs that fade with age.

25. Exercise can cause hypoglycemia in diabetics because:

    1. A. Exercise blocks glucagon release
    2. B. Exercise breaks down the insulin dose
    3. C. Sweating removes glucose
    4. D. Muscles take up glucose faster
    Show answer

    Answer: D. Muscles take up glucose faster

    Active muscle uses glucose and becomes more insulin-sensitive, sometimes for hours afterward.