Hypo/Hyperglycemia Administrative Guideline

Question 1

History

Answer 1

• Recent illness or infection
• Past medical history
• Insulin pump?
• Pertinent medication history
• PO or Sub Q interventions
• Recent treatments
• Treatment compliance

Question 2

Signs and symptoms

Answer 2

• Altered mental status
• Kussmaul breathing
• Polyuria
• Tachycardia
• Weakness

Question 3

Differential

Answer 3

• Stroke
• Head injury/Trauma
• Drug usage
• ETOH usage

Question 4

Abnormal FSBS with symptoms

Answer 4

Assess mental status/GCS
Assess prehopstial stroke screen as indicated
O 2 to maintain sat ? 94%
Vital Signs

Question 5

Hyperglycemia

FSBG >250

Answer 5

Consider NS/LR fluid bolus 10 mL/kg over
one hour
IV/IO access
Cardiac monitor

Question 6

Pediatric hyperblycemia

Answer 6

New onset hyperglycemia in pediatric patients

requires ED evaluation

Question 7

Hypoglycemia BLS

FSBS<60

Answer 7

Administer oral glucose 1 tube (25g)
ONLY IF ALERT AND ABLE TO SWALLOW
May repeat x 1

Question 8

Hypoglycemia ALS

FSBS<60

Answer 8

IV/IO access
Cardiac monitor
Administer Dextrose 10% (D10) 1 mL/kg
(max dose 250 mL) IV/IO
May repeat x 1 for continued symptomatic hypoglycemia
If unable to establish IV access, administer glucagon 0.1
mg/kg (max 1 mg) IM/IN. May repeat x 1 after 10 min

Question 9

After oral glucose or dextrose

Answer 9

Reassess vital signs, FSBS, mental status

Consider Treat and Release AG
Consider BLS Transport Thresholds

Question 10

HYPOglycemic patients feel

Answer 10

anxious or exhibit diaphoresis, tachycardia, or hypotension; others are asymptomatic

Question 11

HYPERglycemic patient are often

Answer 11

asymptomatic and do not need prehospital treatment of their hyperglycemia, especially
if chronic. Other patients may feel thirst, urinate frequently, or experience malaise; even others progress to developing acidosis or altered mental status from complications of hyperglycemia in such diseases as diabetic ketoacidosis and hyperosmolar hyperglycemic state

Question 12

Why should you avoid administration of narcotics or anxiolytics in the setting of DKA?

Answer 12

Tachypnea is important to

maintaining the patient’s precarious acid-base status.

Question 13

Hypoglycemia treat and release guidelines

Answer 13

• Not actively vomiting/is tolerating oral intake
• Patient had adequate response to single dose of dextrose - with VS in BLS range, normal mentation, and
  FSBG within normal limits.
• Patient has no acute conditions other than hypoglycemia (chest pain, shortness of breath, intoxication, liver
  disease, kidney disease, or febrile illness).
• Patient only on short acting insulin or premixed analog (e.g. NovoLog® 70/30 or Humalog® 70/30)
• Patient is not taking oral agents (other than metformin) for blood glucose control.
• Patient released to competent adult
• Patient or legal guardian refuses transport or patient and providers agree transport is not indicated

Question 14

What do you do with hypoglycemic patients with insulin pumps?

Answer 14

• ALOC/AMS ? stop insulin pump or disconnect at insertion site.
• GCS 15 & able to take oral glucose ? leave connected with pump running.