In a conscious patient with type 1 diabetes experiencing hypoglycemia, the recommended initial treatment is:

• A. 15-20 g fast-acting carbohydrate; recheck in 15 minutes; treat again if still hypoglycemic; provide a snack after recovery.
• B. Inject glucagon intramuscularly immediately.
• C. Inject a full dose of insulin to prevent rebound hyperglycemia.
• D. Wait and drink water and rest.

Answer: (A)

When a conscious patient with type 1 diabetes develops hypoglycemia, the fastest and safest move is to give about 15–20 g of fast-acting, easily absorbed carbohydrate. This rapidly raises blood glucose and can be reassessed quickly. Recheck his or her glucose in about 15 minutes; if still below the target (often around 70 mg/dL), repeat the treatment. Once glucose has normalized, provide a snack to prevent recurrence, especially if another meal or dose of insulin is impending.

Examples of suitable options include 4 ounces of juice or regular soda, a small handful of glucose tablets (enough to total roughly 15–20 g), or a teaspoon or two of sugar dissolved in water. Do not delay treatment to drink water, and avoid giving insulin or permitting withholding of carbohydrates. Glucagon is reserved for cases where the patient cannot swallow or is unconscious, not for a conscious, able-to-swallow patient.