Hypo or Hyperglycemia

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):
  • 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.
  • For pediatric administration dilute DEXTROSE 50% to DEXTROSE 25% if available and refer to Broselow® Tape.
    • If DEXTROSE 50% (25gm) is not available then administer Dextrose 10%% mixed in 250 ml bag (1gm/10ml) of solution to deliver an amount as per the total grams indicated on the Broselow® tape (0.5 gm/Kg).
  • If unable to obtain IV access, GLUCAGON 1 mg IM or IN.
    • If patient is between 10 kg (22lb) - 20 Kg (44lb) .5 mg IM or IN.
    • Call for dosage order in pediatrics < 10 kg (22lb).
    • GLUCAGON onset of action in 8-10 minutes.
• If LIMITED or NO response after initial DEXTROSE 50% only:
  • DEXTROSE 50% 12.5 gm IVP for adults if available.
  • For pediatric administration dilute DEXTROSE 50% to DEXTROSE 25% if available and refer to Broselow® Tape.
• 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;