Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

A 67-year-old woman on insulin is waking up with headaches. What is the most likely cause?

1. Dawn effect

2. Menopause

3. Late-night snacking

4. Middle-of-the-night hypoglycemia

The correct answer is: Middle-of-the-night hypoglycemia

The most likely cause of the woman's headaches upon waking is middle-of-the-night hypoglycemia. When individuals are on insulin, it can sometimes lead to lower blood sugar levels during the night, especially if they have not properly adjusted their insulin doses or their nighttime eating patterns. This drop in blood sugar can trigger a release of counterregulatory hormones like adrenaline and cortisol, which can lead to symptoms such as headaches and can disrupt sleep. Events occurring during the night might not be noticed by the individual, leading to a cycle of decreased awareness of hypoglycemic episodes. In this case, the headaches are likely a result of the body's response to the hypoglycemic state experienced while the individual was sleeping. The other options, while they can impact overall health and glucose levels, are less directly related to the acute symptom of waking up with a headache. The dawn effect involves a natural increase in blood glucose levels in the early morning due to hormonal changes, which would not typically cause headaches. Menopause may bring about various symptoms, but headaches specifically tied to blood sugar fluctuations are more closely associated with hypoglycemia. Late-night snacking, while it could potentially cause fluctuations in blood sugar, would not usually result in waking up with a headache if the intake was