Hypoglycemia

Question 1

Initial Considerations..

Answer 1

• HX of Type 1 Diabetes
• Stroke
• Head injury/Trauma
• Drug usage
• ETOH usage

Question 2

How Many Steps

Question 3

Step 1

Answer 3

Initial Assessment

• FSBG
• Mental Status/GCS
• Stroke Screen
• Possible Pump

Question 4

Step 2 (FSBG <60)

Answer 4

Administer Up to 2 Tubes of Oral Glucose

*If Pt Deteriorates and becomes Altered, move on to Step 3

Question 5

Step 3 (FSBG <60 & Altered)

Answer 5

Obtain IV Access

Administer D10 1mL/kg
(250mL MAX dose) IV/IO

*May repeat 1x for continued symptomatic hypoglycemia

*If unable to get IV Access, move onto Step 4

Question 6

Step 4

Answer 6

Glucagon 0.1mg/kg (max 1 mg) IM

*May repeat 1x after 10min

Question 7

Step 5 (After TX)

Answer 7

Reassess:
- VS
- Mental Status
- FSBG

Consider:
- Treat & Release AG
- BLS Transport Thresholds AG (Depending on Underlying Cause)

Question 8

Consider consultation with medical direction for patients that do not meet what criteria..

Answer 8

• 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 9

If the Pt has an insulin pump, when do you leave it on?

Answer 9

If the Pt:

• Able to tolerate PO’s & has a GCS of 15

Question 10

If the Pt has an Insulin Pump but is Altered..

Answer 10

Stop the Pump, if not possible, disconnect it at the insertion site

Question 11

Most common complications of Insulin Pump Therapy on the skin &/or soft tissue?

Answer 11

• Local reactions to tape & adhesives
• Local allergic reactions to insulin preparations
• Lipohypertrophy & Lipoatrophy
• Cellulitis/infection

Question 12

Most common Insulin Pump Malfunctions?

Answer 12

• Incorrect program selected
• Battery Failure
• Cracked or Kinked tubing
• Leaky Reservoirs
• Slippage of the Subcutaneous needle