Hyperglycemia

Hyperglycemia protocol guidelines NMAS

EMS Diagnosis of hyperglycemia

Blood glucose reading of 400 mg/dL or higher

Required Vitals

• BGL

• Spo2

• Heart Rate'

• Respiratory Rate

• NIBP

• Etco2

Required Equipment

• First in Bag

• Cardiac Monitor

• Moving Device

• Glucometer

Assessment Procedures

• BGL (reassess every 15 min)

• Etco2

• 12 Lead

• FAST-ED if altered

Interventions

• 500 ML normal saline max 2L

• IV/IO

MOI/HPI

• Tachypnea

• Inadequate Insulin or Meds

• Fruity Breath

• Hypotension

• Abdominal Pain

Differential Diagnosis

• CVA/TIA

• Altered Mental Status

• Hyperkalemia

• Sepsis/ Septic Shock

• DKA or HHS

Code 3 if:

• Blood glucose does not improve after intervention

• Positive FAST-ED

• Hypotension occurs after initial bolus

What happens when you correct DKA too fast?

Cerebral Edema

Interfacility Transfer

Continue insulin infusion started by sending facility normally .1 units/kg/hour

If blood glucose is dropping faster than 100 mg/dL per hour during interfacility transfer-

• Reduce insulin rate by 50-75%

• If hypoglycemia occurs reduce or stop insulin infusion and exit to hypoglycemia guideline