What is the recommended treatment for severe hypoglycemia in a patient who cannot swallow?

• A. Oral glucose tablets.
• B. Injectable glucagon 1 mg IM; or IV dextrose if available.
• C. Intravenous saline only.
• D. Subcutaneous insulin.

Answer: (B)

When someone has severe hypoglycemia and cannot swallow, the first goal is to raise blood glucose quickly with nonoral therapy. Injectable glucagon given IM at a 1 mg dose is ideal because it stimulates the liver to release stored glucose into the bloodstream, helping restore blood glucose rapidly even if the person is unconscious or unable to swallow. If an IV line is available, giving intravenous dextrose is another fast, reliable option to correct the hypoglycemia.

Oral glucose tablets can’t be used here since swallowing is not possible, and intravenous saline won’t correct the low glucose level on its own. Administering insulin would worsen the situation.

So the best approach is glucagon IM, with IV dextrose as an alternative if IV access is available.