For a diabetic patient, which of the following signs indicates that oral glucose tablets should be given: polyuria and polydipsia; fruity‑smelling breath with positive urine ketones; shakiness and sweating; bradycardia with orthostatic hypotension?

Oral Glucose Tablets Should Be Given for Shakiness and Sweating

The correct answer is shakiness and sweating—these are classic autonomic symptoms of hypoglycemia that indicate the patient is awake, able to swallow, and requires immediate oral glucose administration. 1

Why Shakiness and Sweating Indicate Need for Oral Glucose

Recognition of Hypoglycemia Symptoms

Hypoglycemia manifests through two distinct symptom categories that help guide treatment decisions:

• Autonomic symptoms include sweating, trembling (shakiness), warmness, anxiety, and palpitations—these result from catecholamine release as blood glucose falls below 70 mg/dL 1, 2
• Neuroglycopenic symptoms include confusion, weakness, drowsiness, difficulty concentrating, slurred speech, and dizziness—these reflect inadequate glucose supply to the brain 1, 3, 2

When a patient presents with shakiness and sweating, they are demonstrating early autonomic warning signs while still conscious and able to swallow safely. 1

Treatment Protocol for Conscious Hypoglycemic Patients

For any person with suspected hypoglycemia who is awake and able to swallow, oral glucose should be administered immediately. 1

The specific treatment approach:

• Give 15-20 grams of oral glucose tablets as the first-line treatment 1, 4
• Glucose tablets are superior to dietary sugars, demonstrating better symptom resolution at 15 minutes compared to alternatives like orange juice, jellybeans, or milk 1, 5
• Recheck blood glucose in 15 minutes—if still below 70 mg/dL or symptoms persist, repeat the 15-20 gram dose 4
• Once glucose trends above 70 mg/dL, provide a meal or snack with protein and complex carbohydrates to prevent recurrence 4

Why the Other Options Are WRONG

Frequent Urination and Excessive Thirst (Polyuria and Polydipsia)

These are cardinal symptoms of hyperglycemia, not hypoglycemia—giving glucose tablets would worsen the problem. 1

• These symptoms indicate elevated blood glucose levels requiring insulin or other hypoglycemic agents, not additional glucose
• This represents the opposite metabolic state from what oral glucose treats

Fruity-Smelling Breath with Positive Urine Ketones

This presentation indicates diabetic ketoacidosis (DKA), a severe hyperglycemic emergency. 1

• Fruity breath odor results from acetone production during ketosis
• Administering oral glucose would be contraindicated and potentially dangerous
• This patient requires immediate emergency care, IV fluids, and insulin—not oral glucose

Bradycardia and Orthostatic Hypotension

While hypoglycemia can cause cardiovascular symptoms, the typical presentation includes tachycardia (fast heart rate), not bradycardia. 1, 3

• Bradycardia with orthostatic hypotension suggests other pathology (cardiac conduction abnormalities, volume depletion, autonomic dysfunction)
• This is not a recognized presentation of hypoglycemia requiring glucose tablets
• The autonomic response to hypoglycemia produces sympathetic activation with increased heart rate, not decreased 3, 2

Critical Safety Considerations

When NOT to Give Oral Glucose

Oral glucose should never be administered to people who are not awake or not able to swallow—this risks fatal aspiration. 1, 6

If the patient exhibits any of the following, activate EMS immediately and do NOT give oral glucose: 1

• Unconsciousness or inability to follow simple commands
• Seizure activity
• Inability to swallow safely
• No improvement within 10 minutes of oral glucose administration

For these severe cases, parenteral treatment (IV dextrose or glucagon 1 mg IM/SC/intranasal) is required instead. 1, 4

Common Pitfalls to Avoid

• Do not use foods with added fat (chocolate, candy bars with nuts, milk) as initial treatment—fat delays glucose absorption 4
• Wait the full 15 minutes before re-treating or calling EMS for mild symptomatic hypoglycemia, as symptoms may not resolve immediately 1
• Do not confuse hyperglycemic symptoms (polyuria, polydipsia, fruity breath) with hypoglycemia—this could lead to dangerous mistreatment 1

Patient Education Summary

Teach patients to recognize that shakiness, sweating, trembling, anxiety, and feeling jittery are the warning signs that should prompt immediate glucose tablet administration. 1, 4, 2 These autonomic symptoms represent the body's early defense mechanism and indicate the patient can still safely self-treat with oral glucose before neuroglycopenic symptoms (confusion, altered consciousness) develop. 1, 2