Hypo/Hyperglycemia

Question 1

Hypoglycemia is defined as a glucose level of ___ (range) mmol/L

Answer 1

<4

Question 2

The goal of care in prehospital hypoglycemia is to restore normal glucose levels __________ (in the field / in the hospital)

Answer 2

in the field

Question 3

Hyperglycemia is defined as a glucose level of ___ (range) mmol/L

Answer 3

> 11

Question 4

The goal of care in prehospital hyperglycemia is to restore normal glucose levels __________ (in the field / in the hospital)

Answer 4

in the hospital

Question 5

Common causes of hypoglycemia include: (up to 5)

Answer 5

• Missing a meal
• Insulin dosing not monitored over time
• Over exertion without matching food intake
• A recent change of diabetic medication
• An overdose of insulin or oral hypoglycaemics, accidental or intentional

Question 6

Ketoacidosis is generally only seen in __________ (insulin-dependent / non-insulin-dependent) diabetes

Answer 6

insulin dependent

Generally high circulating levels of insulin in non-insulin-dependent diabetes inhibits lipolysis required for ketogenesis

Question 7

Glucogel may be administered as ___ (quantity) package to the oral mucosa

Answer 7

1

Question 8

Glucagon reverses hypoglycemia by accelerating the breakdown of liver _____

Answer 8

glycogen

Note that glucagon is therefore ineffective if liver glycogen is unavailable, i.e. with prolonged malnutrition/hypoglycemia

Question 9

The onset of glucagon is typically _____ (range) minutes

Answer 9

8-10

Question 10

Contraindications for glucagon administration are (list 2)

Answer 10

• Allergy or hypersensitivity to glucagon

- Pheochromocytoma (A rare tumor involving the adrenal gland)

Question 11

Adult dosing for glucagon is ___ (dose and route)

Answer 11

1mg IM

Question 12

Pediatric dosing for glucagon is ___ (dose) if less than ___ kg and ___ (dose) if greater

Answer 12

0.5mg if less than 25 kg and 1.0mg if greater

Question 13

Pediatric patients are those ___ (age range) years old for the purposes of correcting hypoglycemia

Answer 13

18 years old or less

note that PCPs must complete pediatric IV training before initiating an IV on a child <12 years old

Question 14

Adult dosage of IV dextrose for correcting hypoglycemia is _____ (range in grams)

Answer 14

10-25g

Question 15

Adult dosage of IV D10W for correcting hypoglycemia is _____ (range in mL)

Answer 15

100-250mL

Question 16

Precautions when delivering IV D10W include (list 2)

Answer 16

• Extravasation causes tissue necrosis.

- Consider consultation with clinical support before administration if cerebral bleed is suspected

Question 17

Pediatric dosage of IV D10W for correcting hypoglycemia is _____ mL/kg

Answer 17

5mL/kg

PCPs must complete pediatric IV training before initiating an IV on a child <12 years old

Question 18

If a patient with an altered mental status has suspected hypoglycemia, paramedics _____ (should / should not) pause the functioning of their insulin pump.

Answer 18

should

Question 19

A hypoglycemic, pediatric patient with a mass of 22kg (48.4lbs) may receive _____ (dose in mL) of IV D10W to correct hypoglycemia

Answer 19

110mL

Pediatric dosage of IV D10W for correcting hypoglycemia is 5mL/kg

Question 20

Pediatric patients with undiagnosed insulin-dependent diabetes will initially present with __________ (hyperglycemia/hypoglycemia)

Answer 20

hyperglycemia