Giving any substance by mouth to an unresponsive person is dangerous. The answer to whether oral glucose should be administered to an unconscious patient with suspected low blood sugar (hypoglycemia) is no. This rule is based entirely on the principle of airway safety. An unresponsive state means the body’s natural defense mechanisms are not functioning to protect the lungs, mandating the use of non-oral interventions to raise low glucose levels.
The Danger of Aspiration
The primary risk in giving oral glucose, such as a liquid or gel, to an unconscious person is aspiration. Aspiration occurs when foreign material, like food, liquid, or stomach contents, is inhaled into the lung tissue instead of being swallowed into the esophagus. The body’s natural defense against this is the protective reflex arc, which includes the gag reflex and swallowing.
An unconscious state causes a loss of these protective reflexes, leaving the airway vulnerable. The muscles controlling the epiglottis, which normally seals off the windpipe, become too relaxed to function effectively. Any substance placed in the mouth can easily slide past the larynx and enter the trachea and lungs.
Inhalation of foreign material into the lungs can lead to two complications. The first is immediate airway obstruction, where the substance physically blocks the passage of air, leading to suffocation. The second is aspiration pneumonia, a serious lung infection caused by the presence of foreign material in the lung tissue. This risk is present even with thick glucose gels, as they can still be inhaled.
Identifying Severe Hypoglycemia
Hypoglycemia occurs when blood glucose drops below 70 milligrams per deciliter (mg/dL); severe symptoms typically appear below 54 mg/dL. The earliest signs include shakiness, sweating, and confusion. These symptoms indicate the brain is not receiving enough fuel.
As the condition worsens, the brain’s function becomes severely impaired, leading to neuroglycopenic symptoms. These include slurred speech, extreme clumsiness, and the inability to concentrate or follow simple commands. If low blood sugar is not corrected, it can progress rapidly to seizures and finally to complete unresponsiveness or hypoglycemic coma. Unconsciousness is the definitive sign that the person can no longer safely swallow anything.
Immediate Action and Safe Interventions
If a person is found unresponsive with suspected severe hypoglycemia, immediately call emergency medical services (911 or the local equivalent). While waiting for help, check the individual for medical identification, such as a bracelet or necklace, indicating a diagnosis of diabetes. This information should be relayed to the dispatcher and arriving paramedics.
The safest action is to place the unconscious person into the recovery position, turning them onto their side. This positioning helps keep the airway open. It also allows any fluids, including stomach contents if the person vomits, to drain safely out of the mouth.
Medical alternatives are used to raise blood sugar without compromising the airway. The most common emergency intervention outside of a hospital setting is an injection or nasal spray of glucagon. Glucagon is a hormone that signals the liver to release its stored glucose (glycogen) into the bloodstream, rapidly raising the blood sugar level. This method bypasses the digestive system entirely and can be administered by a trained caregiver.
In a clinical setting or by paramedics, the preferred intervention is intravenous (IV) dextrose, typically a 50% solution, administered directly into a vein. This method is the fastest way to deliver glucose into the circulation. Giving glucose directly into the bloodstream eliminates the aspiration risk entirely, making it the safest and most effective professional treatment when IV access can be established.