Diabetic Emergency Management

Management of diabetes emergency. Minor changes have occurred…
The guidelines have changed to encourage the use of a blood glucometer to check the patients blood sugar levels prior to any treatment – this is only if you are trained in the use of these devices. It is not expected that a first aider will carry a blood glucometer…
If you don’t have a blood gucometer then follow the patients management plan or the accepted general management of a diabetic emergency:
Conscious – 4-5 x 4gm glucose tablets or sugar sweetened drink
Unconscious – manage as per unconscious patient and give no food or drink
The Australian and New Zealand Resuscitation Committee on Resuscitation (ANZCOR) make the following recommendations:
• When available, and trained to do so, use a blood glucometer to check the victim’s blood glucose level.
• When available, glucose tablets are preferred over other sugars for the first aid management of suspected hypoglycaemia in conscious victims.
• When available, and trained to do so, family members and carers use a GlucaGen® HypoKit® glucagon injection to manage suspected hypoglycaemia in an unconscious or seizing victim.

If a person with diabetes has a diabetes management plan then that plan should be followed. If a person with diabetes reports low blood glucose or exhibits symptoms or signs of hypoglycaemia:

·         Stop any exercise, rest and reassure;

·         If the victim is able to follow simple commands and swallow safely, we recommend that first aid providers administer 15-20 grams glucose tablets (4 – 5 x 4 gram glucose tablets) for treatment of symptomatic hypoglycemia

·         If glucose tablets are not available, we suggest administering:

·           Confectionary including:

o    jelly beans (5-20 beans depending on the brand)

o    Skittles® (20-25 candies)

o    Mentos® (5-10 mints),

·           Sugary drinks or sugar-sweetened beverages (approx. 200 mL), but DO NOT administer ‘diet’ or ‘low-cal’ or ‘zero’ or ‘sugar free’ beverages;

·           Fruit juices (approx. 200 mL);

·           Honey or sugar (3 teaspoons);

·           Glucose gels (15 g of glucose gel); and

·         Monitor for improvement – resolution of symptoms would be expected within 15 minutes.

If symptoms or signs of hypoglycemia persist after 10-15 minutes, and the victim is still able to follow simple commands and swallow safely, administer a further 4 x 4g glucose tablets or alternatives as listed above. Once recovered, give a snack with longer acting carbohydrate, for example: 1 slice of bread OR 1 glass of milk OR 1 piece of fruit OR 2-3 pieces of dried fruit   OR 1 snack size tub of yoghurt (not diet or ‘sugar free’ yogurt). If it is a usual meal time, then eat that meal.

If the victim deteriorates, does not improve with treatment, is seizing or is unconscious, call for an ambulance.

·         If the victim is unresponsive and not breathing normally, commence resuscitation

·         If the victim is unconscious but breathing, lie the victim on their side and ensure the airway is clear

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