For Patient A — conscious, cooperative and able to swallow, with a glucose of 54 mg/dL — what do you give?

Correct answer: A. 15 g of oral carbohydrate, such as half a glass of juice or three glucose tablets

• A. CORRECT. This is the RULE OF 15. If capillary glucose is below 70 mg/dL in a CONSCIOUS patient with an intact swallow, give 15 g of rapidly absorbed carbohydrate — about half a cup of juice or regular soda, three or four glucose tablets, or a tablespoon of sugar or honey. Recheck after 15 minutes and repeat if still below 70. Once glucose is normal, give a snack containing complex carbohydrate and protein to prevent recurrence. Note that juice and glucose tablets work whereas chocolate and other fatty confectionery are poor choices, because the fat delays gastric emptying.
• B. Insulin would deepen the hypoglycaemia and could be fatal. It is the classic distractor in this item and the one that must never be selected.
• C. Intravenous dextrose is the definitive treatment for an unconscious hypoglycaemic patient where intravenous access exists, which in most dental settings means waiting for the emergency medical team.
• D. Intramuscular glucagon 1 mg is for the UNCONSCIOUS patient, or anyone who cannot protect their airway or swallow safely. It mobilises hepatic glycogen and takes 10 to 15 minutes to act, and it is far less effective in a starved or alcohol-dependent patient whose glycogen stores are depleted.

Note: The single most useful rule: if you cannot measure the glucose and cannot tell whether a diabetic patient is hyper- or hypoglycaemic, TREAT AS HYPOGLYCAEMIA. Hypoglycaemia causes irreversible neurological damage within minutes; hyperglycaemia takes hours to days. Prevention matters too — morning appointments, confirm the patient has eaten and taken medication as usual, and keep oral glucose in the emergency kit.