A 39-year-old company driver presents with shakiness, sweating, anxiety, and palpitations and tells the nurse he has type 1 diabetes mellitus. Which of the following actions should the nurse do first?
A. Inject 1 mg of glucagon subcutaneously
B. Administer 50 mL of 50% glucose I.V
C. Give 4 to 6 oz (118 to 177 mL) of orange juice
D. Give the client four to six glucose tablets
Correct Answer: C. Give 4 to 6 oz (118 to 177 mL) of orange juice.
Because the client is awake and complaining of symptoms, the nurse should first give him 15 grams of carbohydrate to treat hypoglycemia. This could be 4 to 6 oz of fruit juice, five to six hard candies, or 1 tablespoon of sugar.
Option A: For patients unable to take oral agents, a 1-mg intramuscular (IM) injection of glucagon can be administered. Glucagon can have variable absorption, as it is given SC or IM. It has a relatively slow onset of action and relies on glycogen stores. Therefore, it may not be effective in cachectic patients, those with liver disease, and in young children.
Option B: Severe hypoglycemia can be treated with intravenous (IV) dextrose followed by infusion of glucose. Intravenous administration of 75-80 ml 20% glucose or 150-160 ml of 10% glucose (the volume will be determined by the clinical scenario).
Option D: The nurse may also give two to three glucose tablets for a hypoglycemic reaction. Essentially, a quick-acting carbohydrate needs to be given, followed by a longer-acting carbohydrate.
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