Hypoglycaemia Scenario (ECA)

They have a reduced GCS, but you believe they may still be able to swallow Glucogel. Is reduced responsiveness a caution or contraindication in JRCALC? 

You prepare to give Glucogel but begin with baseline observations: HR 108, RR 18, BP 115/78, SpO₂ 98%, Temp 35.8°C. The wife interrupts and states the patient has a continuous glucose monitor, so you check it — it reads 4.1 mmol/L. The definition of hypoglycaemia is… 

The BM result technically does not classify this as hypoglycaemia. Which other differentials may present similarly? 

You ask about the patient’s drug and medical history. They take Metformin, Gliclazide, Ramipril, Atorvastatin and Aspirin. Their PMH: type 2 diabetes, hypertension, hypercholesterolaemia and a past TIA. Which medications are associated with diabetes treatment? 

Which medication increases the risk of prolonged or recurrent hypoglycaemia? 

No further history explains the patient’s condition. FAST is negative, chest sounds are clear, and the abdomen is soft and non-tender. You question the accuracy of the CGM reading. According to JRCALC, can continuous glucose monitors be relied upon by pre-hospital clinicians in place of capillary testing? 

You take a capillary BM using your equipment and obtain 3.2 mmol/L. You administer a tube of Glucogel. How long should you wait before rechecking the patient’s blood sugar? 

You see improvement in GCS. Your colleague returns and you retest the BM: 3.9 mmol/L. What is the maximum dose of Glucogel? 

You give a second dose of Glucogel. If the patient does not improve, what are the most appropriate next steps as a crew? 

After the second tube, the patient’s BM is 5.5 mmol/L. What should you recommend they take during recovery? 

The wife prepares a sandwich, the patient eats it and makes a full recovery. They had not eaten all day due to working in the garden. They take a sulphonylurea medication (Gliclazide). Does this require further follow-up care? 

Diabetic symptoms can be split into three categories. Confusion falls under: 

Why does hypoglycaemia lead to confusion, irritability, and behavioural changes? 

Continuous glucose monitoring is only supplied to type 1 diabetic patients, and therefore if the patient has one, they should also have a prescription for insulin. 

Which hormone stimulates the liver to release glucose to raise blood sugar (gluconeogenesis)?