In a hypoglycemic diabetic patient with confusion and sweating, what is the most appropriate initial treatment?

In a hypoglycemic diabetic patient with confusion and sweating, what is the most appropriate initial treatment?

• A. 50 mL of 50% dextrose IV
• B. Glucagon if IV access is unavailable
• C. Blood glucose should be checked every 30 minutes
• D. Admit if hypoglycemia is due to sulfonylureas

Answer: (A)

Rapid restoration of blood glucose is the priority when a diabetic with confusion and sweating is hypoglycemic. Giving a bolus of concentrated dextrose directly into a vein raises plasma glucose quickly and reverses CNS symptoms. The standard dose is 25 g of glucose, which corresponds to 50 mL of 50% dextrose given IV. This approach works fast and does not depend on glycogen stores, making it reliable in an acute emergency. If IV access isn’t available, you would use glucagon to mobilize glucose stores, but that option is secondary to the IV dextrose when IV access exists. After giving dextrose, recheck the blood glucose promptly to confirm correction and continue close monitoring, rather than waiting for lab results. Other steps, like simply checking glucose at set intervals for later, or admitting based on cause alone, do not address the immediate danger.

Rapid restoration of blood glucose is the priority when a diabetic with confusion and sweating is hypoglycemic. Giving a bolus of concentrated dextrose directly into a vein raises plasma glucose quickly and reverses CNS symptoms. The standard dose is 25 g of glucose, which corresponds to 50 mL of 50% dextrose given IV. This approach works fast and does not depend on glycogen stores, making it reliable in an acute emergency.

If IV access isn’t available, you would use glucagon to mobilize glucose stores, but that option is secondary to the IV dextrose when IV access exists. After giving dextrose, recheck the blood glucose promptly to confirm correction and continue close monitoring, rather than waiting for lab results. Other steps, like simply checking glucose at set intervals for later, or admitting based on cause alone, do not address the immediate danger.