A 30-year-old man presents to A&E with confusion and rapid heartbeat. He has Type 1 diabetes and has not eaten all day. Capillary blood glucose is 2.4 mmol/L. What is the most appropriate immediate management?

A 30-year-old man presents to A&E with confusion and rapid heartbeat. He has Type 1 diabetes and has not eaten all day. Capillary blood glucose is 2.4 mmol/L. What is the most appropriate immediate management?

• A. Administer 5% glucose orally
• B. Provide a glucagon injection
• C. Administer 10% glucose intravenously
• D. Administer insulin intravenously

Answer: (C)

When there is hypoglycemia with altered mental status, the priority is rapid restoration of blood glucose. An IV dextrose solution provides glucose directly into the bloodstream, quickly raising the level to reverse confusion and prevent further deterioration. Using a 10% dextrose infusion delivers a substantial amount of glucose promptly and is appropriate when the patient is unable to safely swallow or protect their airway. Oral glucose isn’t suitable here because of confusion, which raises the risk of aspiration. Glucagon can be considered if IV access isn’t available, but its effectiveness depends on having sufficient hepatic glycogen stores; in someone who hasn’t eaten, those stores may be depleted, making glucagon less reliable. Giving insulin would worsen the hypoglycemia. So, the best immediate step is intravenous dextrose administration to rapidly correct the low blood glucose.

When there is hypoglycemia with altered mental status, the priority is rapid restoration of blood glucose. An IV dextrose solution provides glucose directly into the bloodstream, quickly raising the level to reverse confusion and prevent further deterioration. Using a 10% dextrose infusion delivers a substantial amount of glucose promptly and is appropriate when the patient is unable to safely swallow or protect their airway.

Oral glucose isn’t suitable here because of confusion, which raises the risk of aspiration. Glucagon can be considered if IV access isn’t available, but its effectiveness depends on having sufficient hepatic glycogen stores; in someone who hasn’t eaten, those stores may be depleted, making glucagon less reliable. Giving insulin would worsen the hypoglycemia.

So, the best immediate step is intravenous dextrose administration to rapidly correct the low blood glucose.