2-16 ADULT HYPOGLYCEMIA

The true diabetic emergency is that of hypoglycemia (low blood sugar).  This can cause seizures and be fatal if not rapidly recognized and treated.  In the field, when a known diabetic patient is unresponsive and no means to obtain a blood sugar level is available, assume the patient is hypoglycemic.

EMR - Emergency Medical Responder

1. Initial assessment
   1. Last oral intake
   2. Assess if the patient is on diabetic medications, and if so, when was the last dose.
   3. Symptoms onset
   4. Is there a history of recent infections, poor food intake and/or vomiting?
2. If the patient is awake with intact gag reflex, administer one tube of glucose. NEVER PUT ANYTHING IN THE MOUTH OF A PATIENT WHO HAS A SIGNIFICANT DECREASE IN LEVEL OF CONSCIOUSNESS.

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Perform glucometry
   1. If greater than 60 assess for other causes of altered mental status.
   2. If less than 60, or known diabetic with symptoms of hypoglycemia and unable to obtain glucose measurement, treat as hypoglycemic.
2. Consult Medical Control for order to administer 1 mg of glucagon IM. Hypoglycemia should resolve within several minutes. Consider ALS intercept if patient does not respond.
3. Initiate transfer and perform ongoing assessment.
4. Hypoglycemic patients may refuse transport once back to usual mental status, but are at risk to become symptomatic again, and transport should be advised.  Consult Medical Control prior to transport refusal.

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Establish IV.
2. Administer 250 mL of D10 IV if blood glucose less than 60. (D10 is 25g of dextrose in 250mL.)
3. If unable to establish and IV and glucagon has not been administered, administer 1 mg glucagon IM and consider ALS intercept if patient does not respond.
4. Initiate transfer and perform ongoing assessment
5. Hypoglycemic patients May refuse transport once back to usual mental status, but are at risk to become symptomatic again, and transport should be advised.  Consult Medical Control prior to transport refusal.

Intermediate - Perform/Confirm All Above Interventions

1. If an IV cannot be established in a reasonable time frame and patient is critical:
   1. Establish an I/O and administer 250mL of D10. (D10 is 25g of dextrose in 250mL.)
      1. May repeat X1 if patient remains symptomatic after 5 minutes.
      2. I/O D50 can be performed before, after, or as an alternative to IM Glucagon.
2. Hypoglycemic patients may refuse transport once back to usual mental status, but are at risk to become symptomatic again. Consideration should be given to transport, especially if patient does not have someone to watch them nor has higher risk factors for recurrence such as oral medications. If there is any question regarding need for transport, consult Medical Control.

Paramedic - Perform/Confirm All Above Interventions