A fictional 70-year-old inpatient taking insulin becomes sweaty, confused and unable to swallow safely; capillary glucose is markedly low.
Frame the danger first.
- Check capillary glucose promptly in any acute change in consciousness, behaviour or neurological function.
- Assess whether the person can swallow safely and whether intravenous access is available.
- Consider insulin or sulfonylurea exposure, reduced intake, renal or liver impairment, sepsis, alcohol and adrenal insufficiency.
Act, escalate, reassess.
- Call for help and protect airway, breathing and circulation while using the current JBDS/local hypoglycaemia pathway.
- Give route-appropriate protocol treatment promptly and recheck glucose at the specified interval.
- Once safe, provide longer-acting carbohydrate or ongoing glucose support as directed and continue surveillance for recurrence.
- Review diabetes medicines and the precipitating cause before the next dose or discharge decision.
Red flags that change pace.
- Reduced consciousness, seizure, aspiration risk or focal neurological signs that persist after correction
- Recurrent hypoglycaemia, long-acting insulin or sulfonylurea exposure
- Sepsis, organ failure, pregnancy or suspected deliberate overdose
What makes care less safe.
- Giving oral treatment to someone who cannot swallow safely
- Correcting one reading without repeat measurement and recurrence planning
- Restarting the same medicine regimen without explaining why hypoglycaemia occurred
Say the concern plainly.
Severe hypoglycaemia at [time] with glucose [result], symptoms [summary] and swallowing/airway status [summary]. Treatment and repeat results are [list]. Suspected cause is [summary], and ongoing monitoring/medication review is required.