October Tip of the Month - Diabetic Emergencies
Diabetic emergencies are among the most common and potentially reversible causes of altered mental status encountered prehospitally. Rapid recognition is essential to preventing serious complications. Within the ALS-PCS and BLS-PCS, paramedics are empowered and expected to assess, manage and transport patients experiencing hypoglycemia or hyperglycemia safely and effectively.
Whether caring for a known diabetic or an undiagnosed patient with non-specific symptoms, a strong understanding of the pathophysiology, clinical presentation and treatment options can be the difference between deterioration and recovery.
Objective
By the end of this tip, paramedics will be able to differentiate between hypoglycemia and hyperglycemia and initiate timely interventions.
Scenario
You’re called to a 52-year-old patient at home who is confused and weak. They are diaphoretic, and their spouse reports several days of excessive thirst and frequent urination. What are your next steps?
Key Content
|
Hypoglycemia |
Hyperglycemia |
|
Hypoglycemia occurs when blood glucose drops below the threshold required for normal brain function, commonly due to excess insulin, missed meals, or increased exertion. Because brain function relies almost entirely on glucose, hypoglycemia is a true neurologic emergency. Symptoms often include diaphoresis, tachycardia, tremors, confusion, slurred speech, seizures and unconsciousness. |
Hyperglycemia arises from insufficient insulin or insulin resistance. Left untreated, it can progress to diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS)- both of which are life threatening metabolic emergencies. Symptoms often include: polyuria, polydipsia, fruity breath odor, *Kussmaul respirations, vomiting, weakness, or decreased LOC. |
*In diabetic ketoacidosis (DKA), the body cannot use glucose effectively for energy and instead breaks down fat for fuel. This process produces ketones, which build up in the blood and make it acidic. To compensate, the body increases exhalation of carbon dioxide, resulting in the deep, rapid breathing pattern known as Kussmaul respirations.
Paramedic Role & Management Priorities:
|
Hypoglycemia |
Hyperglycemia |
|
Management is largely guided by the patient's presentation: ● If conscious and able to swallow, oral glucose or complex carbohydrates are viable options for raising blood glucose levels. ● If altered or unable to protect their airway, consider administering intranasal Glucagon following the Hypoglycemia Medical Directive ○ Key note: Glucagon only works if the patient has glycogen stores. It is less effective in hypoglycemia related to starvation, alcohol misuse, or adrenal insufficiency. ● (PCP-AIV only) if altered or unable to protect their own airway, consider administering IV Dextrose following the Hypoglycemia Medical Directive |
To manage hyperglycemic patients: ● If the patient is hemodynamically stable: supportive care, continued monitoring and transport. ● If the patient is altered or deteriorating (e.g. signs of dehydration, severe hyperglycemia >20-33mmol/L) consider IV access and BHP patch to consult orders for fluid therapy.
|
Takeaway Message
|
Hypoglycemia |
Hyperglycemia |
|
Always assess blood glucometry in patients with altered mental status. Hypoglycemia can mimic other conditions, such as stroke, intoxication or seizure. Hypoglycemia is fast and reversible - act immediately. |
Hyperglycemia develops gradually but can be life-threatening if left untreated. Prehospital care is primarily supportive, so do not delay transport. Hyperglycemia is slow but dangerous - rapid transport is essential. |
Reflection
If a patient’s sugar comes back critically low, how will you respond? If it’s high, which supportive measures will you prioritize?
For More Information:
https://diatribe.org/diabetes-management/detecting-signs-hyperglycemia-vs-hypoglycemia