A client with type 1 diabetes is brought to the emergency department unresponsive. The blood glucose is 38 mg/dL. What is the PRIORITY intervention?

SEVERE HYPOGLYCEMIA (blood glucose <54 mg/dL with impaired consciousness) is a MEDICAL EMERGENCY. An unconscious client with a blood glucose of 38 mg/dL requires immediate treatment.

Priority treatment:

IV access available: 50% DEXTROSE (D50W) — 25 grams (50 mL) IV push is standard treatment for severe hypoglycemia with IV access; glucose is administered directly into the bloodstream for rapid correction; blood glucose typically rises within 5-10 minutes; NO IV ACCESS (or if IV is delayed): GLUCAGON — 1 mg IM or SubQ (kit given to family for home use); mechanism: stimulates liver to release stored glucose (glycogenolysis and gluconeogenesis); takes 15-20 minutes to work; less effective with alcohol intoxication or prolonged fasting (depleted glycogen stores); INTRANASAL GLUCAGON (Baqsimi): 3 mg — newer delivery method; easier to administer. DO NOT give oral glucose (juice, glucose tablets) to an UNCONSCIOUS client — aspiration risk.

After regaining consciousness: give a complex carbohydrate snack; monitor blood glucose frequently; assess for the CAUSE of hypoglycemia (missed meal, too much insulin, increased exercise, vomiting). INSULIN SHOULD NEVER BE GIVEN — insulin lowers glucose further; would be fatal. HYPOGLYCEMIA CAUSES in diabetes: too much insulin or oral antidiabetic medication; missed or delayed meals; increased physical activity without adjusting medication or intake; alcohol consumption; liver or kidney disease affecting drug clearance.

Clinical manifestations: MILD (BS 54-69): adrenergic — diaphoresis, shakiness, palpitations, hunger, pallor, anxiety.

Moderate: neuroglycopenic — confusion, difficulty concentrating, headache, visual changes.

Severe: seizures, loss of consciousness, coma. RULE OF 15 for conscious clients with mild hypoglycemia: 15g fast carbs, wait 15 min, recheck.