EMT Chapter 26-MCIT-F3-2221 | A1C-U Later: Diabetic Emergencies: Diabetic Emergencies are often the most frequently encountered among EMS calls, but often mistaken for something else. A patient with Hypoglycemia may look like having an overdose, a stroke, an intoxication or even a psychiatric patient. These similarities can lead to assessment errors when  providers rely on assumptions instead of objective findings. This course explores the fundamental differences between Type-1 and Type-2 diabetes, why the brain depends on entirely on glucose for normal functions, and the hypoglycemia assessment trap – the tendency to ignore a simple glucose check with another obvious diagnosis.

The lessons covered are

• Lesson 1:  Pathophysiology and the Hypoglycemia Assessment Trap
• Lesson 2:  Hyperglycemic Crises: DKA vs. HHS
• Lesson 3:  Insulin Toxicity and Complex Hypoglycemia
• Lesson 4:  The Insulin Technology Revolution
• Lesson 5:  Comorbidities and Special Populations

Excerpt from EMT Chapter 26-MCIT-F3-2221 | A1C-U Later: Diabetic Emergencies

Glucagon is a hormone that prompts the liver to release stored glucose. Given to a patient whose own production is blocked or insufficient, it can rapidly raise blood sugar without requiring the patient to swallow anything. That last part is the key. Three formats exist. Traditional intramuscular injection from a glucagon emergency kit. A newer intranasal spray. And an autoinjector. Onset is typically 10 to 15 minutes, with full effect within about 30. Glucagon is appropriate for the unconscious or near-unconscious hypoglycemic patient who cannot safely take oral glucose. Roughly the inverse of the oral glucose criteria.

If the patient cannot maintain their airway or swallow on command, glucagon becomes the field intervention of choice where scope allows. EMT-level glucagon administration varies across states and services, so know the local protocol and carry only what is authorized. Now, glucagon has a few important catches. It will not work in a patient with severely depleted liver glycogen stores. Long-term alcoholics. Malnourished patients. Anyone who has already used up their reserves during a prolonged hypoglycemic episode. After glucagon takes effect and the patient regains consciousness, oral carbohydrates are still needed to sustain the recovery. The hormone effect wears off, and without follow-up carbs, the patient can crash again.

Core Concepts & Takeaways

• Differentiate the pathophysiology of Type 1 and Type 2 diabetes and describe the conditions under which point-of-care blood glucose must be obtained as a mandatory vital sign.
• Differentiate diabetic ketoacidosis from hyperosmolar hyperglycemic state using field-obtainable assessment findings and identify the EMT-scope interventions appropriate to each.
• Apply the EMT-level administration criteria for oral glucose and glucagon in complex hypoglycemia and determine when a hypoglycemic patient requires ALS escalation or mandatory hospital transport.
• Analyze continuous glucose monitor data and insulin pump status to guide field decision-making, including when to suspend or disconnect a pump and what device information must be reported at handoff.
• Evaluate how long-term diabetic complications and special-population factors alter assessment priorities, including silent myocardial infarction, dialysis access precautions, potassium shifts, pediatric cerebral edema risk, and geriatric polypharmacy.