Diabetic Emergency
Hypoglycemia and hyperglycemia management
MODERATE PRIORITY
Quick Differentiation Guide
Hypoglycemia (<60 mg/dL)
- •Onset: Rapid (minutes)
- •Skin: Cool, clammy, pale
- •Mental: Confused, aggressive, seizures
- •Breathing: Normal or shallow
- •Pulse: Rapid, weak
Hyperglycemia (>250 mg/dL)
- •Onset: Gradual (hours-days)
- •Skin: Warm, dry, flushed
- •Mental: Lethargic, coma
- •Breathing: Deep, rapid (Kussmaul)
- •Other: Fruity breath, thirst
Hypoglycemia Treatment
Conscious Patient
- • Oral glucose 15-30g
- • Orange juice 4-6 oz
- • Glucose tablets 3-4
- • Recheck BGL in 15 min
Unconscious/Unable to Swallow
- • D50 25g (50mL) IV push
- • D10 250mL IV infusion
- • Glucagon 1mg IM if no IV
- • Recheck BGL q5 min
Pediatric Dosing
- • D25 2-4mL/kg IV
- • D10 5-10mL/kg IV
- • Glucagon: 0.5mg if <20kg
Hyperglycemia/DKA Treatment
Initial Management
- • High-flow oxygen
- • Large bore IV access x2
- • NS 1L bolus (20mL/kg peds)
- • Cardiac monitoring
Fluid Resuscitation
- • NS 1-2L first hour
- • Monitor for fluid overload
- • Consider potassium after urine output
- • Avoid rapid BGL reduction
⚠️ Do NOT Give Insulin
Prehospital insulin administration is contraindicated
Blood Glucose Reference Ranges
<60
Hypoglycemia
Treat immediately
70-120
Normal Range
Target range
250-400
Hyperglycemia
Fluid therapy
>400
DKA/HHS Risk
Aggressive fluids
Transport Decision
Always Transport
- • Altered mental status
- • DKA/HHS suspected
- • Required D50/Glucagon
- • First episode
Consider Transport
- • Recurrent hypoglycemia
- • No improvement
- • Lives alone
- • Medication issues
May Refuse (if all met)
- • BGL normal x2
- • Alert & oriented
- • Ate complex carbs
- • Responsible adult present