A hospitalized patient with diabetic mellitus 2 is found to have a random blood sugar (RBS) of 48 mg/dL. The patient is conscious, oriented, and able to swallow. What is the first step in management?

1. A

   Start IV 50% dextrose immediately

2. B

   Give oral Carbohydrate tablet

3. C

   Administer insulin

4. D

   Wait and repeat RBS after 1 hour

Appeared in: NORCET 10 Prelims-2026

Explanation

Listen in Hindi

• The patient's blood sugar of 48 mg/dL is in the hypoglycemic range (less than 70 mg/dL).
• For a patient who is conscious, oriented, and able to swallow, the standard and safest first-line treatment is oral administration of a fast-acting carbohydrate.
• This approach is non-invasive and effectively raises blood glucose levels quickly.
• This follows the well-established "Rule of 15" for managing mild to moderate hypoglycemia.

Why Other Options Were Wrong

• Option A: IV 50% dextrose is an aggressive intervention reserved for severe hypoglycemia where the patient is unconscious, unable to swallow, or having seizures. It is not the first step for a conscious and cooperative patient.
• Option C: Administering insulin is strictly contraindicated. Insulin's function is to lower blood glucose, and giving it to a hypoglycemic patient would cause the blood sugar to drop even further, which is extremely dangerous and can lead to coma or death.
• Option D: Waiting and rechecking is inappropriate and dangerous. Hypoglycemia is a medical emergency that requires immediate treatment to prevent potential neurological damage, seizures, or loss of consciousness.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing First-line management of hypoglycemia in a conscious patient in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Prompt recognition and treatment of hypoglycemia are critical nursing responsibilities to prevent severe complications like brain damage, seizures, and coma.
• Nurses must always assess the patient's level of consciousness and ability to swallow before administering any oral substance to prevent aspiration.
• What if the patient was conscious but confused and combative? In this case, if they are unable to safely take oral carbohydrates, the nurse might need to use buccal glucose gel or, if that fails, proceed to parenteral treatment (IM glucagon or IV dextrose) as per facility protocol.

How to Approach the Question

• First, identify the core clinical problem from the stem. Here, the RBS of 48 mg/dL clearly indicates hypoglycemia.
• Next, scan for critical patient status details. The keywords are "conscious, oriented, and able to swallow."
• Link the patient's status to the appropriate treatment protocol. For a conscious hypoglycemic patient, the protocol is always oral carbohydrates first.
• Evaluate the options based on this protocol. Giving an oral carbohydrate tablet directly matches the protocol.
• Eliminate the other options by identifying why they are incorrect for this specific scenario: IV dextrose is for unconscious patients, insulin would worsen the condition, and waiting is dangerous.

Concept Tested & Keywords

• Concept Tested: First-line management of hypoglycemia in a conscious patient.
• Stem keywords: diabetic mellitus 2, random blood sugar (RBS) of 48 mg/dL, conscious, oriented, and able to swallow
• Lead-in keywords: first step in management
• Clinical cues: RBS of 48 mg/dL indicates hypoglycemia.
• Clinical cues: Patient's consciousness and ability to swallow are key factors in determining the intervention.

Question ID

Q5Pq6YFlbBv1DDT6x7iHci

Copy ID

Reference Book

E6 Medicine Davidson Principles Practice 24e p. 761-763

E6 Medicine Harrison 22e Part 2 p. 1140-1142