DIABETIC EMERGENCIES                   

DESIGNATION OF CONDITION

• Signs and symptoms may include any or all of the following:
  • Hypoglycemia - altered mental state, seizures, unconscious, drooling, skin is pale
    and moist, confused, agitated, sudden onset, headache.
  • Hyperglycemia – hot skin, acetone/fruity breath, extended onset, Kussmaul respirations, polyuria, polydipsia, and polyphagia.
  • There may be a history of recent injury, illness or unusual exertion.
  • Consider other causes of symptoms, including alcoholism, psychotropic drug use and poisoning.

EMPHASIS ON PATIENT CARE
Maintain adequate perfusion, glucose replacement if hypoglycemic.

FIRST RESPONDER AND BASIC PRE-HOSPITAL MANAGEMENT

1. Initial Management - Assess airway, breathing and circulation and manage as indicated.
2. Focused H&P - History, physical exam, vital signs.
3. Perform glucometry, if available.

• If BGL < 60 mg/dl:
  • If the patient is conscious and able to self-protect the airway, administer oral glucose.
  • If the patient is unconscious, initiate transport and consider ILS/ALS intercept for intravenous glucose administration.
• If BGL is > 200 mg/dl or registers “HIGH”:
  • Protect the patient’s airway, administer high-flow oxygen, assist ventilations, if indicated and consider ILS/ALS intercept for IV fluids.
    4. If no change in mental status, transport as soon as possible to an appropriate medical facility.

INTERMEDIATE and PARAMEDIC PRE-HOSPITAL MANAGEMENT
5. If the patient has an altered mental state and glucose level is > 110 mg/dl:

• IV access, draw blood sample and initiate an IV of an isotonic solution and bolus at 20 cc/kg if associated dehydration or signs of poor perfusion, otherwise TKO.

6. If the patient has an altered mental state and glucose level is < 60 mg/dl:

• IV access, draw blood sample and initiate an IV of an isotonic solution at TKO.
• Administer 50 % DEXTROSE [25g], IVP into a free flowing line. Repeat dosage, in 5 minutes. If no improvement, recheck BGL and if BGL < 70 mg/dl, administer 3rd amp. of 50% Dextrose.
• Pediatric dose is 1 gm/kg of a 25% DEXTROSE solution (dilute 50cc D50 1:1 with sterile water, give 2-4 ml/kg slow IVP). In neonates, use a 10% Dextrose solution (dilute 50cc D50 in 500ml bag of D5W) at [0.2 gm/kg].
  

7. If thiamine deficiency is suspected (i.e. chronic alcohol consumption, radiation therapy, malnourishment) consider THIAMINE [100 mg] slow IVP or IM (adult), [10-25 mg] slow IVP or IM (pediatric). (Paramedic only).
8. If unable to obtain IV access, consider GLUCAGON [0.5 - 1 mg], IM, or SQ.