A 45 years old female diabetic patient on insulin is brought to hospital in unconscious state. What is the first line of treatment?
**Core Concept**
The patient's diabetic emergency is likely due to hypoglycemia, a condition characterized by abnormally low blood glucose levels. The body's primary response to hypoglycemia is the release of counter-regulatory hormones, including adrenaline, cortisol, and glucagon, which stimulate the liver to release stored glucose (glycogen) into the bloodstream.
**Why the Correct Answer is Right**
The first line of treatment for hypoglycemia is the administration of glucose to rapidly increase blood glucose levels. This can be achieved through the oral administration of glucose tablets or a sweet-tasting liquid, or in severe cases, intravenous glucose. Glucagon, a hormone produced by the pancreas, can also be administered to stimulate the liver to release glucose into the bloodstream. Glucagon acts by binding to glucagon receptors on the surface of liver cells, triggering the activation of adenylate cyclase and the subsequent increase in intracellular cyclic AMP (cAMP) levels, which stimulates glycogen breakdown and glucose release.
**Why Each Wrong Option is Incorrect**
**Option A:** This is incorrect because administering insulin in a patient with hypoglycemia would further lower blood glucose levels, exacerbating the condition.
**Option B:** This is incorrect because administering a thiazide diuretic would worsen dehydration and electrolyte imbalances, which are often present in diabetic patients with hypoglycemia.
**Option C:** This is incorrect because administering a beta-blocker would further impair the body's ability to respond to hypoglycemia by blocking the effects of adrenaline.
**Clinical Pearl / High-Yield Fact**
In diabetic patients, hypoglycemia can be caused by taking too much insulin or other diabetes medications, skipping meals, or engaging in intense exercise. It's essential to educate patients on the symptoms of hypoglycemia, which include shakiness, sweating, hunger, dizziness, and confusion, and to have a plan in place for managing episodes of hypoglycemia.
**Correct Answer: C. Administering glucagon.