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Oral Glucose

Category: Pharmacology Sources: raw/supplemental/emt-b-pharmacology.md Last updated: 2026-04-03

Overview

Oral glucose is a simple sugar preparation used to treat hypoglycemia (low blood sugar) in conscious diabetic patients with altered mental status. Trade names include Glutose and Insta-Glucose. It is one of the few medications EMT-Basics can administer — within specific criteria — and is a high-yield exam and field topic.

Key Points

  • Trade names: Glutose, Insta-Glucose (gel formulations)
  • Indications — all three must be present:
  • Altered mental status (confusion, agitation, unresponsiveness — any LOC change)
  • Known history of diabetes (confirmed by patient, family, or medical ID)
  • Able to swallow (patient must be conscious enough to manage the medication without aspiration risk)
  • Dose: One tube (15–25 g), administered by placing gel between the cheek and gum (buccal route). Patient absorbs it through the oral mucosa.
  • Contraindications:
  • Unable to swallow
  • Unconscious or severely altered (aspiration risk)
  • No confirmed diabetic history (do not administer without indication)
  • Reassess: Recheck mental status and blood glucose at 15 minutes. Improvement should be visible.
  • Authorization: Requires standing order or online medical direction per protocol.

Assessment Relevance

The trigger for oral glucose is found during primary-assessment (altered LOC detected on AVPU scale) and confirmed during history-taking (SAMPLE: past medical history includes diabetes, medications include insulin or oral hypoglycemics, last oral intake was a long time ago).

Key scene clues for hypoglycemia: - Medic alert bracelet saying "diabetic" - Insulin syringes or pen found on scene - Glucose meter found on scene - Skipped meal + took insulin → classic setup - Patient appears drunk but no alcohol smell

If blood glucose is available (EMT-B glucometry): BG <70 mg/dL confirms hypoglycemia and supports administration. Do not withhold glucose while waiting for a glucose reading if the clinical picture is clear and the patient meets all three criteria.

Procedures

  1. Complete primary-assessment and confirm altered mental status.
  2. Gather history-taking — confirm known diabetic history.
  3. Confirm patient is conscious and able to swallow (simple swallow test: "Can you swallow?").
  4. Obtain authorization (standing order or contact medical direction).
  5. Open Glutose/Insta-Glucose tube.
  6. Place gel between the cheek and gum using a tongue depressor or gloved finger.
  7. Ensure patient does not aspirate — maintain position.
  8. Reassess mental status and blood glucose at 15 minutes.
  9. Document: time, dose, route, patient response.

If patient deteriorates or loses ability to protect airway after administration: reposition, suction if needed, BVM if necessary.

NM Protocol Notes

  • NM EMT-B scope includes oral glucose administration for altered mental status with known diabetic history and ability to swallow.
  • NM protocols may authorize glucometry at EMT-B level — check current NM EMS Bureau protocol for San Juan region.
  • If blood glucose is available and is <70 mg/dL with the appropriate history, administration is supported.
  • If patient does not improve after one dose and transport time is long, contact medical direction — ALS intercept may be needed for IV dextrose.

NREMT Relevance

Oral glucose is a commonly tested pharmacology topic on the NREMT cognitive (written) exam. Expect questions about: - Correct indications — all three criteria must be met - Contraindication recognition — unconscious patient, unable to swallow - Administration route — buccal (between cheek and gum), not swallowed - Reassessment timing — 15 minutes - What to do if patient deteriorates after administration (manage airway)

Scenario format: "The patient is a known diabetic, appears confused and shaky. They are responsive to verbal stimuli and can follow simple commands. What do you do?" → Administer oral glucose after confirming ability to swallow and obtaining authorization.

Sources

  • raw/supplemental/emt-b-pharmacology.md — Oral Glucose section and General Medication Administration Rules