Hypoglycemia
Low blood sugar has a rapid onset and presents with cool, pale, sweaty skin, tachycardia, confusion, and possible seizures. It can occur after missed meals, excess insulin, or heavy exertion. Treat with oral glucose if the patient can swallow, or IV dextrose or IM glucagon if not.
Diabetic Ketoacidosis
DKA develops over hours to days and presents with warm, dry skin, fruity breath, deep rapid Kussmaul respirations, and dehydration. Blood glucose is usually very high, and ketones accumulate. Prehospital treatment focuses on IV fluids and airway support.
When in Doubt
If you cannot tell the difference, check blood glucose. Hypoglycemia can cause permanent brain injury quickly, while DKA is usually slower to harm. Always reassess mental status and glucose after treatment.