A patient with type 1 diabetes receives intermediate-acting insulin at 0700. Blood glucose is 58 mg/dL at 0900. Which action is appropriate?

• A. Hold all insulin for the day and recheck in 4 hours
• B. Treat with rapid-acting carbohydrate per protocol and reassess
• C. Increase basal insulin dose immediately
• D. Administer IV dextrose 50%

Answer: (B)

When blood glucose drops to 58 mg/dL in a patient with type 1 diabetes on insulin, the priority is to raise it quickly with a fast-acting carbohydrate. The intermediate-acting insulin given earlier can still be active and contribute to hypoglycemia, so treating now helps counteract that effect and restore safe levels. Administer a rapid-acting carbohydrate per protocol (for example, a small serving of juice, glucose tablets, or 15 grams of fast-acting carbs) and then reassess in about 15 minutes to verify that the glucose has risen to a safe range. If it remains low, repeat the carbohydrate treatment as directed by protocol and continue monitoring until above roughly 70 mg/dL. Once stabilized, provide a small snack or meal to prevent recurrence if a meal isn’t soon.

Avoid increasing the basal insulin dose immediately or withholding all insulin for the day, as that would worsen the immediate low or cause hyperglycemia later. IV dextrose is reserved for more severe cases or when the patient cannot take oral carbohydrates or is unconscious.