Hypoglycemia is a low blood sugar, usually under 70 mg/dL, and it happens most often in people who take insulin or sulfonylureas. The brain depends on glucose, so a severe low can cause seizures, coma and death if it is not treated fast.
Key symptoms
- Shakiness, sweating and a racing heart
- Hunger, anxiety and irritability
- Confusion, odd behavior or slurred speech
- Seizures or unresponsiveness in severe cases
What you find on exam
- Airway, breathing, circulation and level of consciousness
- Pale, cool, sweaty skin; fast pulse
- Neuro check: one-sided weakness can mimic a stroke
- Look for clues: insulin pump, medical ID, alcohol, signs of injury
Tests
- Fingerstick glucose: under 70 mg/dL is low, under 54 mg/dL is serious
- Recheck glucose 15 minutes after treatment
- In hospital: look for the cause, such as kidney function, medicines, infection or alcohol
Treatment basics
- Awake and able to swallow: 15 to 20 g of oral glucose, then a snack
- Cannot swallow safely: IV dextrose such as D10
- No IV access: glucagon by intramuscular injection or nasal spray
- Recheck glucose and repeat treatment if still low
- Long-acting insulin or sulfonylureas: watch longer, the low can come back
Red flags
- Seizure or unresponsiveness
- Low glucose that keeps coming back
- On a sulfonylurea or long-acting insulin and wants to refuse transport
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); National EMS Education Standards (2021). Written by Making Synapses. Making Synapses is not affiliated with these organizations.