Hypoglycaemia and diabetic emergencies

Hypoglycaemia commonly presents suddenly in community pharmacy: while someone collects medicines, asks for advice, or waits for a service. It can mimic intoxication, agitation, confusion, or simple collapse unless staff consider it early.

When to suspect hypoglycaemia

Resuscitation Council UK recommends suspecting hypoglycaemia in people with diabetes or chronic malnutrition who develop sudden behavioural change or impaired responsiveness.

• sweating or clamminess
• tremor or shakiness
• poor concentration, odd behaviour, or confusion
• slurred speech
• drowsiness, seizure, or collapse

Immediate treatment when the person is awake and able to swallow

• Give 15 to 20 g of oral glucose if available: glucose tablets, dextrose tablets, or another fast sugar source.
• If glucose tablets are not available: use an alternative sugary drink or sweets.
• If feasible: check a capillary blood glucose and treat if it is below 4.0 mmol/L.
• Repeat after 15 minutes if symptoms persist: then encourage a light snack once they improve.

If the person is unresponsive or cannot swallow safely

Do not give oral sugar, sweets, drinks, or gel by mouth because of the risk of aspiration. Call 999, monitor breathing, and place the person in the recovery position if they are unresponsive but breathing normally. If they become unresponsive and are not breathing normally, follow the cardiac arrest algorithm.

What about hyperglycaemia?

Severely raised blood glucose can cause life-threatening illness. Pharmacy staff should not attempt to correct hyperglycaemia on site. The priority is recognising severe illness and calling 999 if the person is drowsy, vomiting, very dehydrated, breathing abnormally, or becoming less responsive.