Hypo or Hyperglycemia

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Section 5 -MEDICAL

5.10 HYPO / HYPERGLYCEMIA

INITIAL MEDICAL CARE (2.01): Open the airway, provide OXYGEN or assist ventilations as appropriate for patient condition.

  • Obtain history of time of patient's last medication dosage and patient's last meal.
  • Obtain and record blood sugar level.


BLOOD GLUCOSE LEVEL < 100 OR SIGNS & SYMPTOMS OF INSULIN SHOCK / HYPOGLYCEMIA:

  • If patient awake with an intact gag reflex, administer GLUCOSE GEL up to 30 grams orally.
  • If NO response or if patient exhibits ALTERED MENTAL STATUS (5.03):
    • For pediatric administration refer to Handtevy System.
    • Administer DEXTROSE 50% (25gm) IVP for adults through a large patent IV line. Monitor closely for signs of infiltration.
      • If DEXTROSE 50% (25gm) is not available or if the patient has poor venous access, is elderly or frail and/or where high concentration dextrose (D50W) could cause phlebitis or injury;
        • Administer Dextrose 10% (D10) mixed in a 250 ml bag of solution IV Bolus.
          • The entire contents of this bag equal 25 gms of glucose.
          • Administer the entire bag or as much as possible while transporting.
          • If the patient responds quickly to D10, follow treat and release guidelines below.
    • If unable to obtain IV access, GLUCAGON 1 mg IM or IN.
      • GLUCAGON onset of action in 8-10 minutes.
  • If LIMITED or NO response after initial DEXTROSE 50% only:
  • If the patient is a trauma patient or a stroke is suspected: Consider administration of HALF (½) initial dose of D50 or D10 following blood sugar monitoring.


BLOOD GLUCOSE LEVEL > 400 WITH SIGNS & SYMPTOMS OF HYPERGLYCEMIA / KETOACIDOSIS:

  • Administer a fluid bolus of NaCl 200 - 300 ml. Continue IV infusion KVO.

NOTE: Prehospital treatment of HYPERGLYCEMIA is not indicated when only an elevated blood glucose level is present without any other signs and symptoms.


PATIENT TREATED AND RELEASED If a patient has a KNOWN history of Diabetes or Hypoglycemia that has been evaluated by a physician and EMS personnel provided treatment for the hypoglycemia, transport is not required if:

  • The patient’s blood glucose is stable;
AND
  • The patient has a competent adult that will remain with the patient for hours;
AND
  • The patient understands and agrees to eat, re-check blood glucose and call back if necessary;