Dialing 911 For Diabetic Problems

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For those managing diabetes, sugar is a careful agent of balance. Diabetic patients require a clear understanding of their body’s metabolic factors and outside influences that affect their ability to stay within a safe and stable range for their body to operate appropriately.

As an Emergency Medical Dispatcher (EMD), your understanding of diabetes can help you focus on callers’ descriptions for diabetic patients dealing with emergent issues, especially regarding level of consciousness.

Diabetes by the numbers
Diabetes is far more common in the United States than you might expect. In 2021, statistics showed 38.4 million Americans were living with diabetes, representing 11.6% of the population, with about 1.2 million new diagnoses each year.¹

Diabetic patients encounter a difficult journey beyond counting carbohydrates and checking blood sugars. They face increased long-term risk factors for heart disease, stroke, kidney disease, blindness, and medical amputation.² In fact, in 2021, diabetes was the eighth leading cause of death in the United States.³

Type 1 diabetes
The cause of type 1 diabetes is still unknown, though it’s theorized that it may be a form of an autoimmune disease that attacks the pancreas, preventing it from producing enough insulin to process sugars (glucose). Other possible origins include childhood viruses, genetics, and environmental factors.

Symptoms of type 1 diabetes include feeling extremely thirsty and urinating often, sudden bed-wetting in children (with no history), extreme hunger, unexplained weight loss, irritability, weakness, exhaustion, and blurry vision. It remains incurable, though there have been many advancements in numerous device and treatment options aimed at maintaining insulin levels.⁴

Type 2 diabetes
Formerly called “adult-onset diabetes,” type 2 diabetes occurs when the body cannot use insulin, allowing sugar to build up in the blood. The effects of type 2 diabetes aren’t always readily apparent, which is why a significant portion of the population are undiagnosed. Many symptoms are similar to type 1, but type 2 diabetics may also experience slow-healing sores, frequent infections, numbness in hands or feet, and darkened skin in the armpits and neck.⁵

Diabetic emergencies
For diabetic patients, the balancing act of managing energy burned and consumed can feel like a relentless tightrope act—with occasional topples. Diabetic patients may experience concerning disruptions in their blood sugar levels—hypoglycemia (low sugar) and hyperglycemia (high sugar)—or other complications related to their condition.

Hypoglycemia
When a diabetic patient misses or delays meals, exerts energy through exercise, consumes too much alcohol (inhibiting the liver's production of glucose), or takes more insulin than needed for their current food intake, they are at risk of experiencing hypoglycemia.

Readings below 70 milligrams per deciliter (mg/dl) are considered low, and patients dipping below 55 mg/dl may require immediate medical attention.⁶ The patient may experience confusion, dizziness, and nausea; they may feel extremely hungry, shaky, irritable, or anxious; and they may sweat, have chills, become pale, or have clammy skin. Other indicators of hypoglycemia include a rapid heartbeat, weakness, tingling in the mouth, and headaches. Special concern is warranted when the patient demonstrates seizure or changes in consciousness.⁷

Hyperglycemia
On the opposite side, blood sugar levels can become extremely high due to lack of insulin or the body not responding to insulin. This is common when a patient’s diabetes has not been treated or if they are undiagnosed.

Blood sugar levels of 250 mg/dl or higher are considered high, but some patients may show readings in the 600-800 mg/dl range, indicating a more severe spike. These surges of high blood sugar can arise from using expired insulin; facing an illness, infection, or surgical recovery; using certain medications; or experiencing high emotional stress.⁸

Patients with extremely high blood sugar may display unusual behavior or have a fruity smell on their breath. This rather odd-smelling symptom is caused by the presence of ketones in the blood, a byproduct of the body’s metabolism of fat, which is processed when sugars cannot be utilized due to a lack of insulin. In diabetic patients, this process may lead to diabetic ketoacidosis, a serious condition that may lead to dehydration, confusion, coma, brain swelling, kidney damage, heart problems, and even death.

Note that hypoglycemia often has a rapid onset as quick-burning carbohydrates and sugars are used up, while hyperglycemia generally develops over time due to a lack of insulin and may not be as easily recognized.

Due to the rapid onset, the most common calls to emergency services are related to hypoglycemia, which is generally quickly recognized and well tolerated by the body, while the hyperglycemic condition is insidious and more difficult to treat outside of the hospital. Regardless, it is not the EMD’s job to distinguish between these disease processes, but rather to monitor and support the patient until a more definitive diagnosis is made.

Protocol 13: Diabetic Problems
Unlike most Chief Complaint Protocols, Protocol 13: Diabetic Problems is one of only a few protocols structured specifically around a patient’s diagnosis and not always specific to signs, symptoms, or events (see Axioms).

Brett Patterson, IAED Medical Council of Standards Chair, explains this is because the reported diagnosis of a diabetic problem occurring is highly reliable. However, the EMD can sometimes feel confusion whether to address the patient’s diagnosis or laundry list of current symptoms.

“EMDs should focus on what the patient is currently experiencing,” Patterson said. “The current problem may or may not be related to a patient’s medical history.”

Fortunately, the MPDS has built-in safeguards when similar symptoms are handled on different protocols. For instance, if the EMD goes to Protocol 31: Unconscious/Fainting (Near) for an unconscious diabetic patient, either scenario results in the same response level and leads the EMD to airway control and monitoring of the patient. As IAED Medical Academics & Standards Expert Bryon Schultz states, “Either Chief Complaint Protocol is seen as an acceptable pathway in case evaluation.”

Key Questions
If the patient is unconscious at Case Entry, there are no Key Questions necessary prior to sending a 13-D-1 response. For conscious patients, the EMD asks whether the patient is responding normally (completely alert), behaving normally now, and breathing normally. If the answer is “No” to any of these questions, the EMD will send a CHARLIE-level response.

EMDs may be surprised to note that Protocol 13 does not ask for the diabetic patient’s exact diagnosis (type 1 or type 2), nor does it ask for the patient’s blood sugar reading. This is intentional because neither factor influences the response code.

The patient’s current condition, specifically their level of consciousness, is a clearer indication of their immediate needs than their blood sugar reading. In fact, in an alert patient, an abnormal blood sugar level alone will usually warrant a 13-A-1 response, most often used to transport patients who have no way to get to the hospital themselves.

Post-Dispatch Instructions
After sending an appropriate response, it’s appropriate for the EMD to send the caller (or bystanders) to find an AED for an unconscious or not alert patient, providing CPR/airway instructions if needed. This ensures appropriate care even if the problem isn’t related to their diabetic diagnosis.

“There’s a high risk of aspiration in unconscious patients, so they need to be monitored,” Patterson said. “They can die because they vomited and aspirated, not because of the blood sugar problem itself.”

In conscious patients, abnormal blood sugar levels may cause the patient to be combative (indicated with the C suffix and a Dispatch Life Support Link to Case Exit Panel X-8). Patterson describes combative patients as more reactive than aggressive or violent. “Diabetic or seizing patients may rip out their IVs, push paramedics away, or flail their arms out of distress and confusion,” he said. “Others may cower in fear.” In these cases, PDIs advise that callers (and bystanders) observe the patient and protect them from themselves.

A frequent cause of discussion is whether the diabetic patient should be instructed to eat or drink. On most Chief Complaint Protocols (and in Case Exit Instructions), the EMD provides a warning to prevent consuming food or beverage (in case the patient’s condition worsens), but this precaution is omitted if the diabetic patient is alert and can follow their doctor’s recommendations. The same is true with administering prescribed medication.

“We do not want people pouring honey or soda down someone’s throat, agitating the patient or possibly causing asphyxiation, a far more life-threatening condition,” Schultz said. “A good rule of thumb is ‘if they can do it themselves, let them.’”

However, Patterson adds, “Unless specifically advised by their health care provider, it is generally best to await the arrival of responders to ensure an accurate blood sugar measurement. Giving a diabetic patient sugar may produce dramatic results but it is rarely, if ever, lifesaving. It certainly won’t help the hyperglycemic patient, and it may compromise the airway if the patient is symptomatic. If the patient is alert, there is time to await a more thorough evaluation.”

Conclusion
Though diabetes can most often be managed well with careful attention, the EMD is an indispensable resource in sending help when outlier emergencies occur. Your role in providing instructions not only helps the patient but also prepares caring callers with clear guidance in a moment of concern.

Most often, diabetic patients’ needs are best addressed within the hospital setting, but sending appropriate resources and monitoring the unconscious patient could be critical to help ensure a positive outcome.

Sources
1. “Statistics about Diabetes.” American Diabetes Association. 2025. diabetes.org/about-diabetes/statistics/about-diabetes (accessed Sept. 9, 2025).

2. News Staff. “You're Probably Not Afraid Of This One Thing Most Likely To Hurt You – Diabetes.” Science 2.0. 2008; Oct. 28. https://www.science20.com/news_releases/youre_probably_not_afraid_ one_thing_most_likely_hurt_you_diabetes (accessed Sept. 9, 2025).

3. See note 1.

4. Mayo Clinic Staff. “Type 1 Diabetes.” Mayo Foundation for Medical Education and Research (MFMER). 2024; March 27. mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011 (accessed Sept. 9, 2025).

5. Mayo Clinic Staff. “Type 2 Diabetes.” Mayo Foundation for Medical Education and Research (MFMER). 2025; Feb. 27. mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193 (accessed Sept. 9, 2025).

6. “Treatment of Low Blood Sugar (Hypoglycemia).” U.S. Centers for Disease Control and Prevention. 2024; May 15. cdc.gov/diabetes/treatment/treatment-low-blood-sugar-hypoglycemia.html (accessed Sept. 12, 2025).

7. Villines, Z. “Types of diabetic emergencies and how to manage them.” Healthline Media UK. 2025; Feb. 26. medicalnewstoday.com/articles/317436 (accessed Sept. 9, 2025). 

8. Mayo Clinic Staff. “Hyperglycemia in diabetes.” Mayo Foundation for Medical Education and Research (MFMER). 2025; April 30. mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631 (accessed Sept. 9, 2025).