Neuroglycopenic signs: confusion, neurological deficits, altered mental status
Review:
Diabetes history, insulin regimen, and adherence
Nutritional intake and recent fasting or NPO status
MANAGEMENT
If unconscious or confused:
Call for assistance
If IV access available → Give 50 mL of 50% dextrose IV
If no IV access → Give Glucagon 1 mg IM/SC and establish IV access
Recheck glucose in 10–15 minutes → If < 3.5 mmol/L, repeat treatment
If conscious, alert, oriented:
Give orange juice, glucose tablets, or a spoon of honey
Recheck in 10–15 minutes → If still < 3.5 mmol/L, repeat oral intake or give IV dextrose
POST MANAGEMENT
Look for underlying cause
Acute illness?
New meds (e.g., insulin, sulfonylureas)
Hold short-acting insulin or any contributing hypoglycemic agent
Monitor capillary glucose q30min for 2 hours
ESCALATION
If glucose remains < 3.5 mmol/L or if recurrent episodes → Call for assistance → Consider starting a dextrose infusion → Evaluate for ICU transfer if unstable or altered LOC
