Why Your First Responders Might Misinterpret Your Low

The dispatch notes are limited and read: altered mental status. 

Dispatch relays to the medics that the patient’s husband called 911 stating she is “just not acting right.” When they arrive on scene, they find a 54-year-old female lying on the bathroom floor.  

The husband says that she hasn’t been feeling well all day. 

The medics note that her skin is cool to the touch and clammy, and that her pulse feels fast.  

She isn’t responding to them talking to her, so they give her a sternal rub.  Her speech is slurred and they cannot understand what she is trying to say to them.  

The paramedics start to think and ask questions like:

• Is she having a stroke? 
• Did she fall and hit her head? 
• Maybe she had too much to drink? 

These are all things that run through a paramedics mind as they are assessing a person  and the environment they’re in. Trust me, after 10 years of responding to 911 calls, I know. We’re trained to think big and to run  through a list of medical possibilities  to avoid getting too focused on one diagnosis.  

I also know that it can be easy to misinterpret hypoglycemia (low blood sugar) when responding to a medical call. Here’s why.

Why a hypoglycemic low gets misread

Common symptoms of hypoglycemia look a lot like other medical conditions, including:

• Stroke
• Head injury
• Sepsis (a body-wide infection response)
• Drug overdose
• Electrolyte imbalance

And maybe the most frustrating one for people with diabetes: getting mistaken for being drunk.

Your brain runs almost entirely on glucose, a form of sugar, using it as fuel to power thinking, memory, movement and consciousness. So when your blood glucose drops too low, brain cells can’t produce the energy they need, and symptoms show up like:

• Confusion
• Impaired judgment
• Slurred speech
• Sweating
• Tremors (shaking of one or more body parts)

If glucose levels keep falling, the brain starts shutting down critical functions. That can lead to a change in mental status, seizures, unconsciousness and, if untreated, death.

For first responders, this gets even more confusing when bystanders describe what they saw before EMS arrived:

• “They were staggering around. I’m not sure where they came from.” 
• “It’s obvious they’re drunk. They keep slurring when they talk.” 
• “We called 911 because she’s having a panic attack and we couldn’t calm her down.” 

From these statements, we can see bystanders usually have good intentions but sometimes provide stigmatizing and biased views for first responders to navigate when supporting a person in having a medical emergency.  This can impact a person’s treatment and outcomes. 

The training gap 

Diabetes-related emergencies are a core part of Emergency Medical Technician (EMT) and paramedic education programs.  Specifically, they’re taught to recognize both hypoglycemic and hyperglycemic emergencies. Hypoglycemia is considered one of the most reversible causes of altered mental status and accounts for roughly 2% of all 911 calls. 

Across the country, EMS education emphasizes that diabetes-related emergencies should be considered in any person with altered mental status, unusual behavior, seizure activity or unexplained unconsciousness. That’s because symptoms alone are often unreliable and can mimic numerous other medical conditions.  

Simple enough, right? So why isn’t hypoglycemia always the first thing that’s ruled out? 

When first responders arrive on scene, it isn’t always noted that the person lives with diabetes.  It’s common for the call to be presented as: 

• “Unconscious person”
• “Person acting strangely”
• “Possible overdose”
• “Stroke symptoms”

So now responders are tasked with sorting through a wide range of possibilities of what could be the root cause of the problem.  

On top of that, first responders can fall prey to confirmation bias. This occurs when clinicians form an early impression of the problem, then unconsciously seek evidence that supports it while discounting conflicting information. In fact, current literature supports this as a huge contributor to diagnostic error, with EMS being particularly vulnerable to it.  

First responders often hear from dispatch, family members or bystanders before they ever see the person. Like all of us, they’re susceptible to anchoring on that first story, which can unconsciously shape how they read the scene once they arrive.

What changes the outcome

So, as someone who has been diagnosed with diabetes, how can you mitigate these risks and contribute to your own medical care to create a great outcome? 

One way is to have a Medical Alert ID.  This can be a bracelet, necklace, wallet card, or show up on your smart watch and will disclose information about your condition like: 

• Your medical history (i.e. diabetes, high blood pressure, etc.)
• Medications (i.e. insulin, lisinopril, vitamins, etc.)
• Allergies
• Emergency contacts

EMS are taught in training to look for these and it’s a fast way to get them all of your information.  

First responders are also trained to look at your smartphone. Both iPhone Medical ID and Android Emergency Information can be accessed from your lock screen. They contain the same information as a Medical Alert ID and are invaluable if you are unable to provide information.  

You should also  discuss your medical condition and treatment with the people around you. EMS research shows that family members, bystanders, and caregivers often provide critical background information that helps first responders establish a patient’s baseline condition, reduce diagnostic uncertainty and make more informed treatment decisions. No immediate family around? You can also inform a neighbor, co-worker or travel companion instead.  

Key information includes:

• What type of diabetes you live with
• How you personally experience symptoms
• Where you keep emergency glucagon
• How your continuous glucose monitor (CGM) alarm works
• How to access emergency contacts
• When to call 911
• How to identify your insulin pump and CGM

That last point matters more than it might seem. A National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) study found that about 20 to 25% of people with type 1 diabetes have impaired awareness of hypoglycemia (IAH), meaning they often don’t recognize early low blood sugar symptoms themselves. The same study found that roughly 10% to 15% of insulin-treated people with type 2 diabetes experience hypoglycemia unawareness too.

The bottom line

Living with diabetes can make lows unpredictable. But you can control how ready the world around you is. A medical alert ID, a five-minute conversation with the people in your life, a quick setup of your phone’s medical information—none of it takes long, and it can make a big difference in an emergency.

If you’ve lived through a moment where diabetes was misunderstood, your voice could help someone else avoid it. Become a Beyond Type 1 Ambassador today!