You enter the room of your known diabetic patient and find them unresponsive. After ensuring they are breathing and have a patent airway, you check a blood glucose and find it to be 30 mg/dL. Which of the following medications should be the priority to administer?

15-30g oral carbohydrates.

10% dextrose continuous IV infusion

Glucagon PO,

50% dextrose in water (050W) IV push

Answer and Explanation

The Correct Answer is D

A. 15-30g oral carbohydrates:
Oral carbohydrates are a first-line treatment for hypoglycemia in a conscious, alert patient who can safely swallow. However, since the patient is unresponsive, administering oral carbohydrates is not an appropriate option. The patient’s inability to swallow safely increases the risk of aspiration, making IV treatment the priority in this case.

B. 10% dextrose continuous IV infusion:
A 10% dextrose IV infusion can be used in the management of hypoglycemia, but in an acute, emergency setting where the patient is unresponsive and their blood glucose is critically low (30 mg/dL), a rapid-acting intervention is needed. A bolus dose of a concentrated solution, such as 50% dextrose, is more appropriate for quickly raising the blood glucose level in this situation, rather than a continuous infusion, which takes longer to achieve an effective increase in glucose.

C. Glucagon PO:
Glucagon is typically used for hypoglycemia in patients who are unconscious or unable to take oral glucose. However, glucagon is typically administered intramuscularly (IM) or subcutaneously (SQ), not orally (PO). Administering glucagon orally is ineffective, as it would not be absorbed by the body in the necessary manner to correct hypoglycemia. Therefore, this option is inappropriate.

D. 50% dextrose in water (50% DW) IV push:
When a patient is unresponsive and their blood glucose level is critically low (30 mg/dL), the priority treatment is an immediate, concentrated source of glucose. Administering 50% dextrose IV push is the most appropriate intervention in this scenario. It provides a rapid and effective increase in blood glucose levels, which is critical for reversing hypoglycemia in an emergency situation. This is the fastest and most direct approach to treating severe hypoglycemia in an unresponsive patient.

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Correct Answer is B

Explanation

A. 2-6 hours before meals:
This timeframe is too long for rapid-acting insulin like Lispro. Rapid-acting insulins, such as Lispro, begin to work quickly after administration, typically within 15 minutes, and peak around 1 to 2 hours after injection. Administering it 2-6 hours before meals would not align with the timing of food intake and would likely lead to hypoglycemia before the meal. Timing of rapid-acting insulin should be closer to the meal to match the rise in blood glucose levels that occurs after eating.

B. Lispro lasts 24 hours and does not have to be timed with meals:
This statement is incorrect. Lispro is a rapid-acting insulin, and its duration of action is much shorter than 24 hours, typically lasting about 3-5 hours. It is crucial to time the administration of Lispro with meals to match its peak action with the rise in blood glucose levels after eating. A long-acting insulin would be the type that lasts for 24 hours, but that is not the case with Lispro.

C. 15-30 minutes before meals:
Lispro is a rapid-acting insulin, and its onset of action occurs within 15 minutes after injection. It is most effective when administered within 15-30 minutes before the start of a meal, as it peaks in about 1-2 hours and works to regulate blood glucose levels during and after the meal. This timing ensures that insulin works in concert with the rise in blood glucose following food intake, helping prevent hyperglycemia.

D. 60 minutes before meals:
Administering Lispro 60 minutes before a meal is too early. Rapid-acting insulins, such as Lispro, begin working quickly and reach peak action within 1-2 hours. If administered too far in advance, there is a risk that the insulin may have peaked before the meal, leading to a potential drop in blood glucose levels before the meal is consumed. This could result in hypoglycemia. Therefore, administering it closer to the meal, within 15-30 minutes, is the optimal timing.

A. HD cholesterol 60 mg/di B. Total cholesterol 210 mg/at C. LDL cholesterol 110 me di D. Hgb A1C 5.3%

Correct Answer is C

Explanation

A) "HDL cholesterol 60 mg/dL":
This is not a risk factor. High-density lipoprotein (HDL) is often referred to as "good cholesterol" because it helps remove excess cholesterol from the bloodstream, lowering the risk of atherosclerosis and cardiovascular disease. An HDL level of 60 mg/dL is considered protective against cardiovascular disease, as higher levels of HDL are associated with a lower risk of heart disease.

B) "Total cholesterol 210 mg/dL":
This is not a significant risk factor on its own. While total cholesterol above 200 mg/dL is a general indicator for cardiovascular risk, it is not as important as the breakdown of individual lipid components (HDL, LDL). A total cholesterol of 210 mg/dL is only slightly above the ideal less than 200 mg/dL, and on its own, it is not a strong indicator of increased cardiovascular risk without considering other factors like LDL and HDL levels.

C) "LDL cholesterol 110 mg/dL":
. Low-density lipoprotein (LDL) is known as "bad cholesterol" because it can lead to the buildup of plaque in the arteries, increasing the risk for atherosclerosis, heart disease, and stroke. An LDL level of 110 mg/dL is considered to be above optimal. For individuals at risk for cardiovascular disease, the target LDL cholesterol level is usually less than 100 mg/dL, and for those with high risk, it may be less than 70 mg/dL. Therefore, this level of LDL cholesterol places the client at increased risk for cardiovascular disease.

D) "Hgb A1C 5.3%":
This is not a risk factor. An Hgb A1C of 5.3% is within the normal range for glycemic control. The American Diabetes Association defines normal A1C as below 5.7%. A1C levels between 5.7% and 6.4% are considered pre-diabetes, and a level of 6.5% or higher indicates diabetes. A normal A1C level indicates no significant elevated blood glucose, which would be a risk factor for cardiovascular disease.

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You enter the room of your known diabetic patient and find them unresponsive. After ensuring they are breathing and have a patent airway, you check a blood glucose and find it to be 30 mg/dL. Which of the following medications should be the priority to administer?

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