A conscious patient with hypoglycemia should receive which initial treatment?

• A. 15 grams of fast-acting carbohydrate; if unable to swallow, IV dextrose or intramuscular glucagon
• B. 50 mL of 50% dextrose
• C. Inhaled insulin
• D. Oral glucose tablets 4 grams

Answer: (A)

When a patient is conscious and hypoglycemic, the priority is to raise blood sugar quickly with something they can swallow. The best initial approach is to give about 15 grams of fast-acting carbohydrate—things like glucose tablets, fruit juice, or regular soda—so glucose enters the bloodstream rapidly. After giving this, recheck blood glucose in about 15 minutes and repeat if still low.

If the patient could not swallow or there is a risk of airway compromise, the alternative options are IV dextrose or intramuscular glucagon, since those bypass the need to swallow and act quickly to raise glucose.

Other choices don’t fit the scenario as well: 50% dextrose given IV is a valid rescue when swallowing isn’t possible, but it isn’t the first step for someone who is conscious and able to take carbohydrates orally. Inhaled insulin would worsen hypoglycemia by increasing insulin levels, not glucose. Four grams of oral glucose is usually too little to promptly correct the hypoglycemia; the standard initial oral dose is about 15 grams.