Hypoglycaemia — ORE Part 1 MCQ

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EasyHuman Disease & Dental ManagementHypoglycaemiaORE Part 1

A 45-year-old man with type 1 diabetes becomes sweaty, tremulous, and confused during a dental procedure. His blood glucose is 2.8 mmol/L. He is still conscious and able to swallow. What is the most appropriate initial management?

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Correct answer: C — Give oral glucose (15–20 g of fast-acting carbohydrate)

Explanation lettering: D = shown as A · C = shown as B · A = shown as C · E = shown as D · B = shown as E

The patient is conscious and able to swallow, which is the critical discriminator. UK guidance (NICE NG17, multiple NHS regional protocols) mandates oral fast-acting carbohydrate as first-line treatment for conscious hypoglycaemic patients. Give 15–20 g of glucose: options include fruit juice (150–200 ml), dextrose tablets (5–7), or glucose gel (10–20 g). Recheck blood glucose after 10–15 minutes. Intramuscular glucagon (B) is reserved for patients with impaired consciousness or inability to swallow. Emergency call (C) is not immediately necessary if the patient responds to oral glucose; it becomes necessary only if consciousness deteriorates or no response after 15 minutes. Recovery position (D) is passive and inappropriate without treatment. IV dextrose (E) is invasive and unnecessary in a conscious, swallowing patient and is reserved for hospital settings with IV access and unconscious or unstable patients.

Reference: NICE NG17 Type 1 Diabetes in Adults: Diagnosis and Management (2015); Northumberland Tyne and Wear NHS Foundation Trust Protocol for the Treatment of Acute Hypoglycaemia (July 2017); Birmingham and Solihull IMOC Management of Hypoglycaemia in Primary Care (April 2023). https://www.nice.org.uk/guidance/ng17/chapter/recommendations