Understanding Diabetic Emergencies
Diabetic emergencies are among the most common medical calls in EMS and are frequently tested on the NREMT. The two primary presentations are hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar). Distinguishing between them and knowing the appropriate treatment is critical for both the exam and clinical practice.
Hypoglycemia
Hypoglycemia occurs when blood glucose drops below 70 mg/dL. Signs and symptoms include altered mental status, confusion, combativeness, diaphoresis (sweating), tachycardia, weakness, seizures, and unresponsiveness. Onset is rapid, often within minutes. The most common cause in diabetic patients is taking too much insulin, skipping meals, or excessive physical activity. Hypoglycemia is a true emergency because the brain depends on glucose for function.
Treating Hypoglycemia
If the patient is conscious and able to swallow, administer oral glucose (one tube of glucose gel, approximately 15 grams). Place the gel between the cheek and gum and have the patient swallow. Reassess blood glucose after 15 minutes. If the patient is unresponsive or unable to swallow, do not administer oral glucose due to aspiration risk. Maintain the airway, provide supportive care, and transport. Paramedics can administer IV dextrose or IM glucagon.
Hyperglycemia and Diabetic Ketoacidosis
Hyperglycemia develops gradually over hours to days. Signs and symptoms include polyuria (frequent urination), polydipsia (excessive thirst), polyphagia (excessive hunger), Kussmaul respirations (deep, rapid breathing), fruity breath odor, warm and dry skin, and altered mental status. Diabetic ketoacidosis (DKA) is a life-threatening complication of severe hyperglycemia. EMT treatment focuses on airway management, oxygen administration, and rapid transport.
Key Exam Distinctions
The NREMT expects you to differentiate between hypoglycemia and hyperglycemia. Remember: hypoglycemia has rapid onset and requires rapid intervention (oral glucose). Hyperglycemia has gradual onset and requires hospital-level care. When in doubt, treat for hypoglycemia first because it is more immediately life-threatening. Giving glucose to a hyperglycemic patient is unlikely to cause significant harm, but failing to treat hypoglycemia can result in brain injury or death.