Hypoglycemia Refusal & Capacity
Objective: After D10 or oral glucose, decide who can actually refuse: oriented, fed, not on a long-acting secretagogue, and protocol-legal.
Why This Is Hard
They woke up mean and want you gone. ADA teaching treats symptomatic glucose <70 as hypoglycemia. Refusal after treatment is a capacity plus bounce-back risk problem — not a signature on a blank.
- Recheck glucose and orientation after treatment.
- Ask the actual med: insulin vs sulfonylurea. Long-acting oral agents bounce back.
- They need a food plan they can actually swallow. If they will not eat, they ride.
Field Rules (Education)
- Capacity: oriented, understands the risk of going back down, not still drunk, not post-ictal.
- High-risk refusals: sulfonylureas, long-acting insulin, alcohol, no responsible adult, no food, elderly living alone.
- OLMC exists for a reason. Use it when the protocol says so.
- Document pre/post glucose, what they ate, who is with them, and the warning you gave.
Field Pitfalls
- Refusal while GCS is still 13.
- No food plan.
- Skipping the med list.
Practice
60-second drill
Partner: (1) young insulin, ate a sandwich, GCS 15, roommate home; (2) elderly glyburide, lives alone, wants you gone. Who rides.
Related: Diabetic emergencies, D10.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- ADA Standards of Care 2025 — treat symptomatic hypoglycemia; bounce-back risk with secretagogues
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.