Hypoglycemia: sudden onset, cool clammy skin, fast pulse, confusion or odd behavior.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A known diabetic is confused, sweaty and following simple commands, and swallows without difficulty. Your glucose meter shows an error on every attempt. The most appropriate action is to:
Answer: A. A confused, sweaty diabetic who can swallow is presumed hypoglycemic; oral glucose treats that fast and does little harm if the sugar turns out high. Waiting for a working meter leaves the brain starved. Withholding everything by mouth is right only when he cannot swallow or protect his airway.
Question 2 of 3
A confused diabetic's glucose reads 312 mg/dL. Your partner reaches for the oral glucose. You should:
Answer: A. Oral glucose treats hypoglycemia; with a measured high glucose it adds nothing and the confusion needs another explanation — infection, stroke, hyperglycemic crisis, a head injury. Confusion in a diabetic points to low sugar only until a reliable reading says otherwise.
Question 3 of 3
A diabetic patient is awake, oriented and able to swallow, with a history of taking insulin and not eating. The appropriate action is to:
Answer: A. An awake patient who can swallow can be treated immediately, and improvement after glucose is itself diagnostic. Withholding treatment leaves a correctable cause uncorrected, and waiting for drowsiness means waiting for the patient to lose the ability to take it safely.
Keep the streak going with more questions like these, each with a full rationale.
Key points to remember
- Hypoglycemia: sudden onset, cool clammy skin, fast pulse, confusion or odd behavior.
- Hyperglycemia: slow onset, warm dry skin, thirst, frequent urination, dehydration.
- DKA: fruity breath and deep rapid breathing (Kussmaul) with abdominal pain.
- Oral glucose only if awake, able to swallow and able to protect the airway.
- Recheck mental status and glucose after treatment; skipped meals and new insulin doses are clues.
Field priorities
- Altered patient: check glucose early — it is quick and changes treatment.
- Unable to swallow: nothing by mouth; manage the airway and request advanced care.
- Hyperglycemia with shock signs: treat the shock and transport.
Coaching the patient
- When unsure whether sugar is high or low, glucose for the awake patient does little harm.
- An 'intoxicated' patient may be hypoglycemic — check before assuming.
Red flags: act now
- Unresponsive diabetic patient
- Kussmaul breathing with altered mental status
- Low sugar in a patient on long-acting medication — it can return
Diabetic Emergencies: FAQs
What are the priority actions for Diabetic Emergencies in the field?
Altered patient: check glucose early — it is quick and changes treatment. Unable to swallow: nothing by mouth; manage the airway and request advanced care. Hyperglycemia with shock signs: treat the shock and transport.
What findings in Diabetic Emergencies change your plan or your transport decision?
Unresponsive diabetic patient. Kussmaul breathing with altered mental status. Low sugar in a patient on long-acting medication — it can return.
What do I need to know about Diabetic Emergencies for the NREMT?
Hypoglycemia: sudden onset, cool clammy skin, fast pulse, confusion or odd behavior. Hyperglycemia: slow onset, warm dry skin, thirst, frequent urination, dehydration. DKA: fruity breath and deep rapid breathing (Kussmaul) with abdominal pain. Oral glucose only if awake, able to swallow and able to protect the airway.
What should the crew communicate or document for Diabetic Emergencies?
When unsure whether sugar is high or low, glucose for the awake patient does little harm. An 'intoxicated' patient may be hypoglycemic — check before assuming.
