A nurse teaches a client with diabetes mellitus about sick day management. Which statement should the nurse include in this client's teaching?

Choice A rationale: Atherosclerosis is a common complication of diabetes, but it's a macrovascular complication, not a direct result of diabetic neuropathy. Neuropathy affects the nerves, while atherosclerosis involves the hardening and narrowing of arteries due to plaque buildup, which is a separate but related long-term complication of hyperglycemia. Choice B rationale: Diabetic retinopathy is a microvascular complication of diabetes that affects the blood vessels in the retina of the eye. It is not caused by neuropathy. Neuropathy affects peripheral nerves, leading to sensory, motor, or autonomic dysfunction, and is a distinct complication of diabetes. Choice C rationale: Diabetic neuropathy, particularly peripheral sensory neuropathy, causes a loss of protective sensation in the feet. Patients cannot feel pain, pressure, or temperature, making them unaware of injuries, blisters, or cuts. This lack of sensation places them at high risk for undetected foot injuries, which can lead to ulcers, infections, and even amputation. Choice D rationale: Kidney failure is a complication of diabetic nephropathy, which involves damage to the small blood vessels in the kidneys (glomeruli). It is not a direct result of diabetic neuropathy. While both are microvascular complications of diabetes, they affect different organ systems and have different pathophysiological mechanisms.

Choice A rationale: Glucose is a primary fuel source, but the body can also use fatty acids and amino acids for energy through metabolic pathways like beta-oxidation and gluconeogenesis. The brain, however, has a high metabolic rate and is highly dependent on glucose as its main energy substrate because fatty acids cannot cross the blood-brain barrier efficiently.
Choice B rationale: The brain is almost exclusively dependent on glucose for its energy needs, as it lacks the ability to store glucose as glycogen and cannot effectively utilize other energy sources like fatty acids. A sustained blood glucose level below the normal range, typically below 60 mg/dL, impairs cerebral function, leading to symptoms like confusion and lethargy.
Choice C rationale: The production of red blood cells, a process called erythropoiesis, occurs primarily in the bone marrow. This process is regulated by the hormone erythropoietin and depends on nutrients like iron, vitamin B12, and folic acid. It is not directly linked to a minimum blood glucose level in the way that brain function is.
Choice D rationale: Lactic acid is produced during anaerobic metabolism when oxygen supply is insufficient, not due to low blood glucose. While severe hypoglycemia can lead to metabolic disturbances, lactic acidosis is typically associated with conditions like shock or certain metabolic disorders, not directly with low blood glucose levels.