Hypoglycemia

57-year-old woman from HOME, independent and using basal-bolus insulin, was found confused after taking rapid insulin and missing lunch. Family reports normal cognition at baseline and no trauma or infection.

Primary survey shows patent airway and adequate breathing. Patient found seated on floor, diaphoretic and confused, GCS 13. BGL low by measured value; no focal deficit or injury. Serial vitals obtained.

Differential considerations: 1) medication-associated hypoglycemia, 2) occult infection causing reduced intake, 3) other metabolic or neurologic cause. Symptomatic low glucose.

Glucose therapy given per applicable guideline with aspiration risk considered. BGL, cognition and oral intake reassessed; patient returned to baseline. Cause, recurrence risk, safety plan and transport recommendation discussed; disposition documented.