A patient with type 1 diabetes presents with tremors, sweating, and confusion after missing meals. What is the immediate management?

• A. Administer a bolus of IV normal saline.
• B. Administer insulin to rapidly correct hyperglycemia.
• C. Place the patient in Trendelenburg position.
• D. Check blood glucose and treat hypoglycemia with fast-acting carbohydrate or IV dextrose if unable to swallow.

Answer: (D)

Hypoglycemia is the immediate concern when a person with type 1 diabetes misses meals, evidenced by tremors, sweating, and confusion as the brain and autonomic system react to low glucose. The priority is to confirm the low blood sugar and raise it quickly. Check the blood glucose right away. If it’s low, treat with a fast-acting carbohydrate that the patient can swallow (for example, juice, regular soda, glucose tablets) and recheck in about 15 minutes. If the patient remains hypoactive or cannot swallow safely, or if there’s no IV access, escalate to IV dextrose to rapidly raise the glucose, or administer glucagon if IV access isn’t available. Insulin would worsen the situation, and giving normal saline alone does not correct hypoglycemia. Trendelenburg position isn’t helpful in this scenario.