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Severe sulphonylurea-associated hypoglycaemia — MRCEM SBA MCQ

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EasyResuscitation and critical illnessSevere sulphonylurea-associated hypoglycaemiaMRCEM SBA

A 78-year-old woman with type 2 diabetes is brought to the emergency department after being found drowsy at home. She lives alone, takes gliclazide and has eaten very little for two days. Her capillary blood glucose is 2.1 mmol/L. She is maintaining her airway and breathing adequately but cannot follow instructions or swallow safely. Intravenous access is established. Which management plan is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Give intravenous glucose, recheck glucose after 10 minutes and admit for monitoring.

Her low glucose requires immediate treatment. Because she cannot swallow safely and intravenous access is available, give intravenous glucose rather than an oral preparation or intramuscular glucagon. Recheck capillary glucose after 10 minutes and repeat treatment if it remains below 4.0 mmol/L. Once she has recovered and can swallow, provide longer-acting carbohydrate. Gliclazide-associated hypoglycaemia can recur after initial correction; her age, poor intake and living alone strengthen the case for admission and continued glucose monitoring. ([nnuh.nhs.uk](https://www.nnuh.nhs.uk/publication/download/hypoglycaemia-in-adults-with-diabetes-mellitus/)) A omits the scheduled glucose recheck: clinical improvement does not establish biochemical recovery. B uses glucose gel despite unsafe swallowing; it would be suitable for a confused patient who can swallow. C offers a route used when intravenous access cannot be obtained, but glucagon may be less effective with sulphonylureas. D treats and rechecks appropriately, yet discharge immediately after recovery overlooks the risk of recurrent hypoglycaemia in this patient. ([nnuh.nhs.uk](https://www.nnuh.nhs.uk/publication/download/hypoglycaemia-in-adults-with-diabetes-mellitus/))

Reference: The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus (January 2023) — https://www.nnuh.nhs.uk/publication/download/hypoglycaemia-in-adults-with-diabetes-mellitus/ For Healthcare Professionals: Hypoglycaemia (2023) — https://diabetesmyway.nhs.uk/media/7505/hcp_hypo_trend_2023-compressed.pdf