This protocol covers adults who are conscious but presenting with altered mental status — confused, disoriented, unable to cooperate, or aggressive — with a capillary blood glucose below 4.0 mmol/L, and who retain the ability to swallow.
The patient is conscious with signs of altered mental status or behavioral changes: confused, disorientated, unable to cooperate, or aggressive. Despite this presentation, the patient is able to swallow. Capillary blood glucose is below 4.0 mmol/L.
Management is guided by the patient's level of cooperation. Where a patient cannot cooperate, a buccal route for rapid glucose delivery is used as the primary step; if this is insufficient, an alternative parenteral agent may be required. Recovery is then consolidated with a carbohydrate step. The full sequence and agent selection is in the protocol.
Capillary blood glucose above 4.0 mmol/L when remeasured 10–15 minutes after treatment.
B. Adults who are conscious but confused, disorientated, unable to cooperate or aggressive but are able to swallow
If the person is not capable and/or uncooperative, but is able to swallow, give 2 tubes 40% glucose gel (e.g. Glucogel®) squeezed into the mouth between the teeth and gums or (if this is ineffective) give glucagon 1mg IM (only licensed for insulin induced hypoglycaemia, glucagon may be less effective in people prescribed sulfonylurea therapy or with a history of alcohol abuse or chronic liver disease).
Once blood glucose is above 4.0mmol/L and the person has recovered, give a long-acting carbohydrate snack (20g) of their choice where possible, taking into consideration any specific dietary requirements.
Repeat capillary blood glucose levels after 10-15 minutes. If it is still less than 4.0mmol/L repeat steps 1 and 3 (no more than 3 treatments in total and only give IM glucagon once).
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