Medical Emergencies · patient case question
What is the immediate management?
Patient case: Type 1 diabetic who skipped breakfast
Patient: Male, 31 years old
Chief Complaint: Attends a morning appointment for a restoration.
Background: Type 1 diabetes on a basal-bolus insulin regimen. He took his usual morning insulin but forgot to eat breakfast before leaving the house.
Current Findings: Twenty minutes into the appointment he becomes pale, sweaty and shaky, and reports feeling dizzy and confused. He is conscious and able to swallow.
Vital Signs: BP 118/72 mmHg · HR 104 bpm · Respirations 18/min
Show answer and explanation
Correct answer: D. Give an oral source of glucose
- A. Positioning and oxygen are supportive measures but they do not address the cause. The patient needs glucose.
- B. Emergency services may be needed if he loses consciousness, but a conscious patient who can swallow should be given glucose now rather than left to deteriorate.
- C. Insulin lowers blood glucose further and would be catastrophic here.
- D. CORRECT. Insulin without food equals hypoglycaemia, and the picture — pallor, sweating, tremor, tachycardia, confusion — is textbook. In a CONSCIOUS patient with an intact swallow, give 15–20 g of fast-acting oral carbohydrate immediately: glucose tablets, juice, or regular soft drink. Recheck in 15 minutes and repeat if needed. When in doubt between hypo- and hyperglycaemia, GIVE SUGAR — the harm of a little extra glucose in a hyperglycaemic patient is trivial, while untreated hypoglycaemia causes brain injury within minutes.
Note: If consciousness is LOST, oral glucose becomes an aspiration hazard. Then it is intramuscular glucagon 1 mg, or intravenous 50% dextrose if access is available, plus activation of emergency services.
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