Which scenario among patients with diabetes is most likely to be hypoglycemic?

• A. 21-year-old female who ate a high-calorie dinner and decreased exercise
• B. 47-year-old male who took his insulin but could not eat
• C. 27 year old acting drunk with liquor odor on breath
• D. 41-year-old who is sick and unable to take insulin

Answer: (B)

When blood glucose is reduced by insulin without an accompanying intake of carbohydrates, hypoglycemia occurs. Taking insulin and then being unable to eat creates a mismatch: insulin lowers blood sugar, but there’s no dietary glucose to compensate, so levels drop and hypoglycemic symptoms can develop. This direct insulin-glucose mismatch makes this scenario the most likely to be hypoglycemic.

The other situations are less likely: a large dinner with less exercise tends to raise blood glucose; alcohol can cause low blood sugar but its effect is variable and not as predictable as the insulin-without-eating scenario; illness without insulin often raises blood glucose due to stress hormones and reduced insulin effectiveness, leading toward hyperglycemia rather than hypoglycemia.