Patients experiencing a diabetic emergency may have a wide range of signs and symptoms, many of which mimic other more common conditions. Regardless, EMS professionals must maintain a high degree of suspicion for diabetes-related illnesses.

While assessing the patient and treating acute life threats, the EMT must search for medical alert tags, information, syringes, and diabetic medications (HINinsulinlin is usually found in the fridge). This information may be critical in recognizing and applying the proper treatments during a diabetic emergency.

Additional areas of the history that are vital when assessing diabetic patients include:

• Onset of symptoms.
• Recent food intake.
• Insulin/oral hypoglycemic medication use.
• Alcohol or drug consumption.

Managing a Conscious Diabetic

If the patient is conscious and able to talk, a pertinent history should be obtained while assessing the patients (ABC's) airway, breathing, and circulation.

If hypoglycemic the patient should be given glucose. Protocol may include drawing blood before the administration of glucose. Most EMS agencies use field glucose testing with a portable glucometer.

Any patient with a blood glucose reading < 80 mg/dl with signs and symptoms of hypoglycemia should promptly receive oral glucose. Known diabetics may refuse transport after the administration of glucose when their levels return to normal. Contact medical command for guidance.

The methods of glucose administration vary from region to region.

• If the patient is conscious and alert, has a gag reflex and is able to swallow properly, sugar may be administered orally.

It may be given in the form of a candy bar, orange juice with sugar, or sublingual/buccal administration of glucose gel. 

• An alternate method is to slowly administer 50% Dextrose through a stable vein, because extravasation of it into the tissues causes necrosis. If D50 is administered, it is advised to transport the patient for evaluation.

Managing an Unconscious Diabetic

The pre-hospital management of an unconscious patient is simple and direct:

• Manage the airway while providing ventilatory and circulatory support as needed (ABC).
• Depending on local protocol, the initiation of any IV fluids (Lactated Ringer's solution or normal 0.9% saline) may be done to replenish electrolytes and fluid.

Before glucose is administered, a blood sample should be drawn for the hospital lab.

If alcoholism or other drug abuse is suspected then medical command may recommend the administration of thiamine, naloxone--or both--prior to the administration of glucose.

If IV access is unobtainable, subcutaneous or intramuscular injection of glucagon may help raise serum glucose levels by stimulating the breakdown of liver glucagon. (Glucagon is not effective on alcoholics and those with liver disease.)

Determining the cause of a diabetic emergency is sometimes difficult in the pre-hospital setting. When the cause is uncertain, finger-stick glucose testing should be done, and all patients should receive glucose if hypoglycemic. The difference in the signs, symptoms, and timeline of the varying diabetic emergencies should be enough to make an initial decision in treatment.