Assessing Diabetic Emergencies: A Guide for Clinicians

Secondary Assessment and History Taking

Once life threats are addressed, the secondary assessment begins. This phase involves a detailed physical exam and a comprehensive history to uncover the underlying cause of the emergency.

History of the Present Episode

When interviewing the patient or bystanders, clinicians must determine the history of the present episode. Key questions include:

• What was the exact time of onset?
• How long has the episode lasted?
• Are there associated symptoms, such as seizures or fever?

The S A M P L E History

A critical component of the secondary assessment is the S A M P L E history, which helps identify if the patient has a pre-existing diabetes diagnosis. Clinicians should look for specific physical and environmental clues:

• Medical ID bracelets or wallet cards.
• Presence of oral medications.
• Availability of a home glucose meter.
• Presence of an implanted insulin pump.

Recognizing Diabetic Emergency Signs

Clinicians must distinguish between the two primary metabolic states: hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar).

Hypoglycemia

Hypoglycemia is often caused by too much insulin, too little food intake, or excessive exercise. It has a rapid onset and can lead to permanent brain damage if not treated quickly.

• Signs: Abnormal behavior (mimicking intoxication), cold, clammy skin, elevated heart rate (tachycardia), hunger, and seizures.

Hyperglycemia

Hyperglycemia develops much more slowly, often over days or weeks. It is caused by insulin deficiency and can lead to Diabetic Ketoacidosis (DKA).

• Signs: Warm, red, dry skin, chronic thirst, increased urination, and an acetone (fruity) odor on the breath.

Objective Data: Blood Glucose Monitoring

If local protocols permit, blood glucose monitoring should be performed to provide objective data. This helps move beyond clinical observation to precise measurement.

Warning: Always question a reading that is inconsistent with the patient's physical symptoms. The meter may be uncalibrated, the strip may be expired, or there may have been insufficient blood application.

Vital Signs and Field Treatment Considerations

The final steps in the assessment involve recording baseline vital signs to monitor the patient's stability throughout the encounter.

When considering field treatments, such as the administration of oral glucose, the most vital assessment is the patient's ability to swallow.

• If the patient is alert and can swallow: Oral glucose may be administered to address suspected hypoglycemia.
• If the patient cannot swallow or has an unprotected airway: Do not administer oral glucose, as this poses a high risk of aspiration. Instead, secure the airway and provide artificial ventilations as needed.

By following this systematic approach—moving from scene safety to primary assessment, and finally to a detailed secondary assessment and glucose monitoring—clinicians can effectively manage the complexities of diabetic emergencies and improve patient outcomes.