Protocol Status: PUBLISHED
Protocol:
Version: 2026.01
Effective Date:
Last Reviewed:
Medical Director Approval:
Clinical Note: This content reflects current GCEMS clinical guidelines as of the dates listed above. If content appears inconsistent with current policy, use the most recent approved guideline and notify leadership for correction.

Altered Mental Status

Diabetic Reaction

 

History:

 

  • Known diabetic; medical alert tag
  • Report of illicit drug use or toxic ingestion
  • Past medical history
  • Medications
  • History of trauma
  • Change in condition
  • Changes in feeding or sleeping habits

 

Significant Findings:

 

  • Decreased mental status or lethargy
  • Change in baseline mental status
  • Bizarre behavior
  • Hypoglycemia (cool, diaphoretic skin)
  • Hyperglycemia (warm, dry skin, fruity breath, Kussmaul respirations; rapid, deep breathing, signs of dehydration)
  • Irritability

 

Differential:

 

  • Head trauma
  • CNS (stroke/tumor/seizure/ infection)
  • Cardiac (MI/CHF)
  • Hypothermia/hyperthermia
  • nfection (CNS and other)
  • Thyroid (hyper/hypo)
  • Shock
  • Diabetes (hyper/hypoglycemia)
  • Toxic ingestion
  • Acidosis/alkalosis
  • Environmental exposure
  • Pulmonary (hypoxia)
  • Electrolyte abnormality
  • Psychiatric disorder

 

Treatment:

 

  • Oxygen
  • Initiate IV
  • Obtain BGL

 

 

Glucose < 60 with signs of hypoglycemia ?

 

  • Yes

 

    • Consider Oral Glucose 1-2 tubes if awake and no risk for aspiration.
    • 10% Dextrose (D10) 250 mL IV

 

 

Glucose > 60 with altered mental status ?

 

  • Yes

 

See appropriate protocol :

 

 

Glucose > 250 with signs of poor perfusion and/or dehydration ?

 

  • Yes

 

    • 12-Lead EKG
    • Normal Saline up to 1,000 mL IV

 

    • Notify receiving facility or contact Medical Control

 

PEARLS:

 

  • Low glucose (less than 60)
  • Normal glucose (60-120)
  • High glucose (greater than 250)
  • Pay careful attention to the head exam for signs of bruising or other injury.
  • While infusing 10% Dextrose (D10) solution, monitor the patient for changes in level of consciousness and signs/symptoms of CHF/pulmonary edema.
  • It is safer to assume hypoglycemia than hyperglycemia if doubt exists.  Re-check blood glucose after administration of Dextrose or Glucagon (GlucaGen).
  • Be aware of altered mental status as a presenting sign of an environmental toxin or Haz-Mat exposure and protect personal safety.
  • Do not let alcohol confuse the clinical picture. Alcoholics frequently develop hypoglycemia and may have unrecognized injuries.
  • Consider restraints if necessary for patient's and/or personnel's protection per the Behavioral Emergencies/Chemical Restraint Protocol.
  • 50% Dextrose (D50) can be given on a case-by-case basis per Paramedic discretion.