A nurse is providing dietary teaching for a client who has Cushing's disease. Which of the following recommendations should the nurse include in the teaching?

A. Polyuria is typically a symptom of hyperglycemia (high blood sugar) rather than hypoglycemia. When blood glucose is elevated, the kidneys attempt to excrete the excess glucose, leading to increased urination.
B. Tachycardia (increased heart rate) is a common sign of hypoglycemia due to the body's stress response to low blood sugar. The release of adrenaline (epinephrine) can cause a rapid heart rate.
C. Blurred vision can occur with hypoglycemia because low glucose levels can affect the function of the retina and cause vision changes. This can resolve once the blood glucose level is normalized.
D. Polydipsia (excessive thirst) is more commonly seen in hyperglycemia, as high blood glucose leads to dehydration due to increased urination.
E. Moist, clammy skin is a classic sign of hypoglycemia. When blood sugar drops too low, the body activates the sympathetic nervous system, which can cause sweating and clammy skin.

A. "Test your blood glucose level every 8 hours.": This is incorrect. During illness, blood glucose levels should be checked more frequently, typically every 2 to 4 hours, to closely monitor for hyperglycemia and prevent diabetic ketoacidosis (DKA). Checking every 8 hours may not be frequent enough, especially if the client is ill or experiencing stress, both of which can affect blood sugar.
B. "Check your urine for ketones when blood glucose levels are greater than 240 mg/dL.": This is the correct instruction. When blood glucose levels exceed 240 mg/dL, it is important to check for ketones in the urine. The presence of ketones can indicate the development of DKA, and early detection can prevent the condition from worsening.
C. "Withhold your usual daily dose of insulin.": This is incorrect. Insulin should never be withheld during periods of illness unless specifically instructed by a healthcare provider. Withholding insulin can increase the risk of DKA, as the body will continue to break down fat for energy in the absence of insulin, leading to ketosis.
D. "Drink 240 to 360 milliliters of calorie-free liquids every 8 hours.": This is not entirely correct. While staying hydrated is important, the recommendation is generally to drink more frequently, ideally 8 ounces of fluid every hour to stay well-hydrated. It is also recommended to drink fluids that contain some carbohydrates (such as electrolyte-containing drinks) to help manage blood glucose levels during illness.