A nurse provides diabetic education at a public health fair. Which disorders should the nurse include as complications of diabetes mellitus? (Select all that apply.)

Choice A rationale: A quiet, dark environment is part of supportive care for a patient with hyperthyroidism, as it can reduce anxiety and sympathetic nervous system stimulation. However, a 1-degree Fahrenheit increase in temperature is a critical early sign of a developing thyroid storm, a life-threatening condition. This action is not the most urgent and is supportive, not a direct intervention.
Choice B rationale: An elevation in temperature, even a slight one, in a patient with Graves disease is a hallmark sign of an impending thyroid storm, a hypermetabolic state that can lead to cardiac dysrhythmias and death. An immediate ECG is crucial to assess for cardiac complications such as tachycardia, atrial fibrillation, and other life-threatening dysrhythmias that can develop rapidly in this emergency.
Choice C rationale: The apical-radial pulse deficit is a measure of the difference between the apical and radial pulse rates. While a significant deficit can indicate a dysrhythmia like atrial fibrillation, which is a concern with Graves disease, assessing the heart's electrical activity via an ECG is a more direct and immediate action to identify and manage the root cause of the cardiac instability.
Choice D rationale: Administering acetaminophen can help reduce fever, a symptom of thyroid storm. However, it does not address the underlying hypermetabolic state or the critical cardiac complications that are the primary danger. It is not the first or most critical action, as a full cardiac assessment via ECG is paramount to guide definitive treatment and prevent a fatal outcome.

Choice A rationale: Taking insulin immediately before exercise can be dangerous for a person with diabetes. Physical activity increases glucose uptake by muscle cells, which, when combined with the effect of exogenous insulin, can lead to a rapid and significant drop in blood glucose levels, resulting in exercise-induced hypoglycemia.
Choice B rationale: Eating a large meal immediately before or during exercise is not the recommended treatment for hypoglycemia. While a large meal will raise blood glucose, it is not the most rapid or efficient method. A concentrated source of simple carbohydrates is required to quickly raise blood sugar to a safe level.
Choice C rationale: Hard candy contains simple carbohydrates, such as sucrose or dextrose, which are rapidly absorbed into the bloodstream. This quick absorption is crucial for reversing the symptoms of hypoglycemia, such as lightheadedness and shakiness, which are caused by insufficient glucose delivery to the brain.
Choice D rationale: For many people with diabetes, adjusting insulin dosage is necessary to prevent hypoglycemia during exercise. However, a blanket recommendation to take no insulin before exercise is not scientifically sound or safe. The appropriate action depends on the type, duration, and intensity of exercise, as well as current blood glucose levels.