A 72-year-old with T2DM on insulin is found confused at home; capillary glucose 2.3 mmol/L. Manage him.

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Accepted Answer

This is severe hypoglycaemia. If conscious with safe swallow I would give rapid-acting oral glucose such as tablets or gel, followed by longer-acting carbohydrate once levels improve. If drowsy or unable to swallow safely I would give IV 10% dextrose, or IM glucagon if IV access is not available. Once stabilised I would monitor glucose closely and ensure he receives longer-acting carbohydrate to prevent rebound. I would then explore the cause — insulin dosing, meal timing, recent illness, renal function, alcohol intake, and whether episodes have recurred. Given his age I would be cautious of overtight glycaemic targets and consider relaxing HbA1c, review his insulin regimen and involve the DSN for education and follow-up. I would admit if there is recurrent hypoglycaemia, he is on long-acting insulin or sulfonylureas, there is hypoglycaemia unawareness or cognitive impairment, or unreliable social support at home.

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