Diabetic Emergencies: Hypo & Hyper

Why This Is Hard

Hypoglycemia can look like stroke, intoxication, or psychosis. Hyperglycemic crises can look like sepsis or dehydration. A fingerstick (or approved meter) early prevents wrong pathways — and still is not the whole exam.

Hypoglycemia

• Diaphoresis, tremor, confusion, seizure, focal deficits, combativeness.
• Risk: insulin/sulfonylureas, missed meals, illness, alcohol.
• Treat per protocol: oral glucose if safe swallow, IM glucagon, IV dextrose concentrations as authorized.
• Reassess glucose and mentation; watch for recurrent hypo (especially long-acting agents).
• Refusal after treatment needs capacity, oral intake plan, and protocol/medical control rules.

Hyperglycemia / DKA / HHS Themes

• Polyuria/polydipsia history, dehydration, Kussmaul breathing (DKA education), fruity odor (variable), AMS.
• Field care is supportive: ABCs, volume per protocol, avoid over-focusing on a single number.
• Do not give insulin in the field unless your system explicitly authorizes it.
• Think sepsis and other triggers; hyperglycaemia may be stress response.

Key Points for Paramedics

• Check glucose early in AMS, seizure, stroke-like symptoms, and unexplained behavior change.
• Focal neuro deficits can be hypo — still follow stroke pathways if residual deficits after correction per protocol.
• Document pre/post glucose, treatment, and response.

Field Pitfalls

• Oral glucose in a patient without a protected airway.
• Assuming “high sugar” explains everything and skipping sepsis exam.
• Leaving high-risk recurrent hypo patients without a solid plan.

Practice

Two scenarios: (1) glucose 32 with AMS; (2) glucose 520 with Kussmaul and dehydration. State first three actions each. Related: AMS framework.

Sources & Further Study

• Your diabetic emergency protocol; ADA education concepts for DKA/HHS awareness.