Endocrane in Critical Care

Diabetic Emergencies

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A. Signs and symptoms: Confusion, restlessness, moist skin, rapid pulse, may loose consciousness or have seizures.

B. Patient history: Patient on insulin or oral hypoglycemic agents who develops the above. Symptoms usually start after a period of a few hours without caloric intake.


II. Administer a substance high in simple sugar, i.e. sugar cubes, commercial glucose, orange juice with 2-3 teaspoons of sugar added.,if hypoglycemia is suspected.

A. Be sure patient isn't allergic to substance being given.

B. Be prepared for patient to vomit.

III. Obtain pertinent medical history, medications, and allergies.

IV. Secondary Survey.

V. Obtain vital signs according to Patient Assessment protocol.

Unconscious or not alert patient

I. Primary Survey. Refer to Altered Mental Status protocol.

A. Protect the airway.


Observe for respiratory depression prepare to assist ventilations


B. Suction; as needed.

II. Administer oxygen.


IV. Obtain pertinent medical history, look for medical alert necklaces, bracelets, anklets, and Vial of Life (Insulin).

V. Obtain vital signs according to Patient Assessment protocol.

VI. Maintain body temperature.

VII. Place a patient on side unless contraindicated.


Observe for respiratory depression, prepare for intubation


3. Monitor EKG.

4. Start IV of NS @ TKO.and perform a glucose level test. If GLUCOSE <80 OR If patient has an altered LOC administer 25 gm of 50% Dextrose IV PUSH. This should be done only if there is a high suspicion of hypoglycemia .


1. Consider repeating 25 gm of 50% Dextrose IV PUSH if altered LOC persists.

2. Further orders per Medical Control.

3. Oral glucose agents will not be given to unconscious patients.

4. Do not delay transport for the administration of oral glucose agents.

5. Often diabetics have acute illnesses secondary to their diabetes and/or illnesses that may exacerbate their diabetic problem.

6. Find out when patient last ate.

7. Determine if and when medications were taken.