Diabetic Emergency- James Format

Applies to: Blood glucose less than 70 mg/dL or greater than 300 mg/dL and

• Patient-reported low or high blood glucose
• Diabetic patients with other medical symptoms (e.g., vomiting)
• Altered mental status
• Alcohol intoxication, suspected
• Seizure
• Stroke symptoms
• Unresponsive patients
• Cardiac arrest

Exclusion Criteria: None

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BLSHistory

• CheckPast bloodmedical glucose levelhistory
• IfMedications
• Drug allergies
• Last Meal
• Last BGA check

Signs and Symptoms

• Altered mental status
• Combative / irritable
• Diaphoresis
• Seizures
• Abdominal pain
• Nausea / vomiting
• Weakness
• Dehydration
• Deep / rapid breathing

Differentials

• Alcohol / drug use
• Toxic ingestion
• Trauma; head injury
• Seizure
• CVA
• Altered baseline mental status

Pearls

• Patient’s refusing transport to medical facility after treatment of hypoglycemia:
  • Blood sugar must be ≥ 80, patient has ability to eat and availability of food with responders on scene.
  • Patient must have known history of diabetes and not taking any oral diabetic agents.
  • Patient returns to normal mental status and has a normal neurological exam with no new neurological deficits.
  • Must demonstrate capacity to make informed health care decisions. See Universal Patient Care Protocol UP-1.
    Otherwise contact medical control.
• Hypoglycemia with Oral Agents:
  • Patient’s taking oral diabetic medications should be encouraged to allow transportation to a medical facility.
    They are at risk of recurrent hypoglycemia that can be delayed for hours and require close monitoring even after
    normal blood glucose is lessestablished.
  than
  • Not 70 mg/dL, administer 10-15 grams ofall oral glucoseagents betweenhave theprolonged patient’action so Contact Medical Control or NC Poison Control Center for advice.
    Patient’s gumwho meet criteria to refuse care should be instructed to contact their physician immediately and
    consume cheek.
  a
  • Administer additional dose of 10-15 grams of oral glucose if not improved after 10 minutes.meal.

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ALS

• Hypoglycemia with Insulin Agents
  • HYPOglycemia:Many Ifforms of insulin now exist. Longer acting insulin places the patient at risk of recurrent hypoglycemia even
    after a normal blood glucose is lessestablished.
  than
  • Not 70all mg/dL,insulins administerhave 10%prolonged dextroseaction inso 50Contact mLMedical (5Control gram)for boluses,advice.
  1
  • Patient’s minutewho apart,meet criteria to arefuse maximumcare ofshould 250be mLinstructed ORto 25contact gramstheir ofphysician 50%immediately dextrose IVP, until:
    • the patient hasand
      consume a return to normal mental status, and
    • the patient’s blood glucose is at least 90 mg/dLmeal.
  • IfCongestive Heart Failure patients who have Blood Glucose > 250:
    • Limit fluid boluses unless patient has persistentlysigns alteredof mentalvolume statusdepletion andsuch bloodas, glucosedehydration, lesspoor thanperfusion,
      hypotension, 90and/ mg/dLor despite treatment, repeat dosing regimen above.
    • If unable to initiate an IV and blood glucose is less than 70 mg/dL, administer glucagon 1 mg IM/IN.
      • If the patient has persistently altered mental status and blood glucose less than 90
        mg/dL at 15 minutes, transport to the hospital should not be delayed.shock.
    • HYPERglycemia:In Ifextreme bloodcircumstances glucosewith isno greaterIV than/ 300IO mg/dL,access administerand 10no mL/kgresponse Lactatedto Ringer’sglucagon, bolusD50 unlesscan rales,be wheezing,administered pedalrectally,
      Contact edema,Medical orControl historyfor of renal failure or CHF is present. advice.

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    MCReferences

    Protocols

    • Not Applicable
      

    Pharmacology

    • Dextrose 10%
    • Dextrose 50%
    • Glucagon
    • Glucose

    Procedures

    • Vascular Access
    •