Understanding What is the PES statement for hypoglycemia?

October 28, 2025 •

3 min read

According to the American Diabetes Association, many individuals with diabetes, especially those on insulin, experience at least one low blood sugar episode every four weeks. For dietitians, documenting and addressing this issue effectively requires a Problem, Etiology, and Signs/Symptoms (PES) statement, the cornerstone of the Nutrition Care Process, which clarifies exactly what is the PES statement for hypoglycemia?.

Quick Summary

The PES statement for hypoglycemia identifies the specific nutrition problem, its root cause, and supporting clinical evidence. It guides registered dietitians in creating a personalized intervention plan to stabilize blood glucose and prevent future episodes, tailoring care to the patient's unique situation.

Key Points

PES Statement Formula: The PES statement follows the structure: Problem related to Etiology as evidenced by Signs and Symptoms.
Hypoglycemia Nutrition Problem: Common nutritional diagnoses include 'Inconsistent carbohydrate intake' and 'Altered nutrition-related laboratory values (hypoglycemia)'.
Etiology for Hypoglycemia: The cause often relates to medication-food timing issues, knowledge deficits, inconsistent meal patterns, or physical activity.
Signs and Symptoms: Evidence for hypoglycemia includes measurable low blood glucose readings ($< 70$ mg/dL) and patient-reported symptoms like shakiness, confusion, and dizziness.
Acute Intervention: Guidelines involving consuming fast-acting carbs and retesting blood glucose are used for treating mild to moderate hypoglycemia.
Preventive Intervention: Long-term management involves consuming small, frequent meals, pairing carbs with protein/fiber, and regular monitoring to stabilize blood sugar.

The Foundation of Nutrition Care: Deconstructing the PES Statement

The PES statement is a standardized tool used by Registered Dietitian Nutritionists (RDNs) to document a patient's nutrition diagnosis. It's a structured way to identify a nutrition problem, its cause, and the evidence supporting it. This is particularly useful for conditions like hypoglycemia, which can have diverse triggers, ensuring interventions are targeted.

Identifying the Problem: The 'P' in PES

The 'Problem' is the specific nutrition diagnosis from the Nutrition Care Process Terminology (NCPT). For hypoglycemia, which is a medical diagnosis, the nutrition problem might be 'Inconsistent carbohydrate intake' or 'Altered nutrition-related laboratory values'. The specific problem chosen depends on the patient's situation and the underlying cause.

Pinpointing the Etiology: The 'E' in PES

The 'Etiology' describes the root cause of the nutrition problem, which is the area the dietitian will focus on for intervention. Common etiologies for hypoglycemia include lack of knowledge about carbohydrate timing or amounts, irregular meal patterns, mismatch between food intake and medication, unplanned physical activity, or alcohol consumption.

Documenting Signs and Symptoms: The 'S' in PES

The 'Signs and Symptoms' are the objective and subjective data that provide evidence for the diagnosis. This includes objective measures like blood glucose readings below 70 mg/dL and subjective reports from the patient, such as feeling shaky, dizzy, or confused.

Sample PES Statements for Hypoglycemia

Here are some examples of how a PES statement might be written for different hypoglycemia scenarios:

Scenario 1: New diagnosis of Type 1 diabetes
- PES: Inconsistent carbohydrate intake related to a food- and nutrition-related knowledge deficit regarding carbohydrate counting as evidenced by frequent client-reported hypoglycemic episodes and limited knowledge of carbohydrate-containing foods.
Scenario 2: Existing diabetes with erratic eating patterns
- PES: Inconsistent carbohydrate intake related to limited food and nutrition knowledge regarding appropriate meal timing as evidenced by diet recall showing skipping of lunch meal, frequent afternoon hypoglycemic episodes (blood glucose $< 70$ mg/dL), and patient report of weakness.
Scenario 3: Frequent nighttime lows
- PES: Altered nutrition-related laboratory values (hypoglycemia) related to an inconsistent bedtime snack pattern as evidenced by recurring nocturnal blood glucose readings $< 70$ mg/dL and patient report of nighttime sweats and waking hunger.

Comparison of Nutrition Interventions: Acute vs. Preventive Care


Feature	Acute Hypoglycemia Intervention	Preventive Hypoglycemia Intervention
Goal	To raise blood glucose levels quickly to a safe range.	To stabilize blood sugar levels throughout the day and prevent future episodes.
Carbohydrate Type	Fast-acting, simple carbohydrates (e.g., glucose tablets, juice, regular soda).	Complex carbohydrates with fiber, protein, and healthy fats (e.g., whole grains, beans, nuts).
Timing	Immediate consumption at the onset of symptoms or confirmed low blood glucose.	Regular, spaced-out meals and snacks every 3-4 hours.
Example	Fast-acting carbohydrates as recommended by a healthcare professional.	A mid-afternoon snack that balances carbohydrates, protein, and healthy fats.
Food Combination	Simple carbs alone for fast absorption.	Pairing carbs with protein or healthy fat to slow absorption and sustain energy.

The Role of Nutrition Intervention in Managing Hypoglycemia

Following the PES statement, a dietitian develops a nutrition intervention plan that includes immediate and long-term strategies.

Short-term Intervention: Addressing Low Blood Sugar

Guidelines are used for treating mild to moderate hypoglycemia:

Consume a specific amount of fast-acting carbohydrates.
Wait and re-check blood glucose.
Repeat if blood glucose is still below 70 mg/dL.
Once stable, eat a balanced snack or meal.

Long-term Prevention: A Balanced Diet

Preventive care aims to reduce the frequency of low blood sugar. Strategies include:

Eating small, frequent meals.
Pairing carbohydrates with protein and healthy fats.
Choosing complex carbohydrates.
Limiting alcohol.
Adjusting food intake for physical activity.

The Conclusion: A Structured Approach to Blood Sugar Management

Creating a precise PES statement for hypoglycemia is crucial for dietitians to develop effective, personalized care plans. By accurately identifying the nutrition problem, its cause, and the supporting evidence, dietitians can implement targeted interventions to treat acute episodes and educate patients on long-term prevention strategies, ultimately improving blood glucose control and overall health.

For more information on the Nutrition Care Process, resources from the Academy of Nutrition and Dietetics are highly recommended: eatrightPRO.org.

Frequently Asked Questions

A PES statement consists of three parts: the Problem (the specific nutrition diagnosis), the Etiology (the root cause of the problem), and the Signs and Symptoms (the evidence supporting the diagnosis).

A medical diagnosis, like 'hypoglycemia,' identifies a disease or condition. A PES statement, used by dietitians, describes the specific nutrition-related problem and its cause that a dietitian can treat, such as 'Inconsistent carbohydrate intake'.

A common etiology for hypoglycemia is 'limited food and nutrition-related knowledge' concerning appropriate carbohydrate intake or meal timing, which a dietitian can address through education.

Signs and Symptoms include objective data like blood glucose readings below 70 mg/dL and subjective reports from the patient, such as feeling shaky, dizzy, confused, or unusually hungry.

The PES statement directs the nutrition intervention. By identifying the root cause (Etiology), a dietitian can develop a targeted plan. For example, if the etiology is 'inconsistent meal timing,' the intervention will focus on establishing a regular eating schedule.

The PES statement is important because hypoglycemia can have multiple causes. It provides a structured way to identify the specific nutrition-related factors contributing to the patient's low blood sugar, ensuring a personalized and effective intervention.

General guidelines for treating mild to moderate hypoglycemia involve consuming a specific amount of fast-acting carbohydrates and retesting blood glucose.