Hypoglycemia

What are differentials for hypoglycemia?

• stroke

• head injury/trauma

• drug usage

• ETOH usage

What are signs and symptoms of hypoglycemia?

• altered mental status

• tachycardia

• weakness

• cold, clammy skin

• hypoxia

Important history questions?

• recent illness or infection

• past medical history

  • insulin pump?

• pertinent medication history

  • PO or Sub Q interventions

  • recent treatments

  • treatment compliance

Steps for treatment of hypoglycemia

1. assess FSBS

   1. If abnormal with symptoms or abnormal VS

2. assess mental status/GCS

   1. assess prehospital stroke screen

   2. maintain SpO2 of greater than or equal to 94%

   3. get vital signs

3. if hypoglycemic (<60), administer 1 tube oral glucose

   1. can repeat 1 time (2 total doses)

4. Reassess VS, mental status, FSBS

What are indications for glucose?

• able to swallow

  • no = IV dextrose(paramedic)

• AMS

• low FSBS (symptomatic)

What are contraindications for glucose?

• allergy

• lack of airway reflex/unable to swallow

• altered consciousness

Transport protocols for glucose

• 1 tube = patient can refuse transport

• 2 tubes = patient must be transport/no option to refuse

What is the difference between Type 1 and Type 2 diabetes?

• Type 1: pancreas can’t secrete insulin, commonly diagnosed young

  • many diabetic emergencies due to too much insulin dosed (hypoglycemia)

• Type 2: cells cannot take insulin, commonly diagnosed in older and obese individuals

Signs and symptoms of hyperglycemia

• >250 FSBS

• eating/drinking a lot

• polyurea(going to the bathroom a lot)

• acetone breath

• Kussmaul Respirations (high RR)

• sweating, hot, flushed skin (diaphoretic)

What is the dosage of 1 tube of glucose?

15 mg

Other signs/symptoms you may find in hypoglycemic patients

• anxious

• diaphoresis

• tachycardia

• hypotension

• some are asymptomatic

Treat and Release AG for hypoglycemia if patients meet following requirements…

• not actively vomiting/tolerate oral intake

• no acute symptoms other than hypoglycemia (ie. chest pain, shortness of breath, intoxication, liver disease, kidney disease, febrile illness)

• pt only on short acting insulin(ie. metformin)

• pt not taking oral agents for blood glucose control (metformin does not apply)

• pt released to competent adult

• pt or legal guardian refuses transport and providers agree transport is not needed

What to do with hypoglycemic patients with an insulin pump?

• ALOC/AMS —> stop insulin pump/disconnect insertion site

• GCS 15/able to take oral glucose —> leave connected with pump running

When is refusal required for a hypoglycemic patient who has been given dextrose?

• not diabetic

• pt on oral hypoglycemic medications

• takes intermediate/long acting insulin