Hypoglycaemia in a known diabetic at a fun run

Patient Information

Dispatch: You are called to a patient (Jake Thornton, 27YO male) who is sitting slumped against a barrier near the finish line of the City to Surf Fun Run, appearing confused and sweaty.
Patient: Jake Thornton — 27yr (80kg)
Incident History: Pt completed approximately 8km of the fun run before slowing down and sitting against a barrier. Bystanders noticed he was confused and not responding to questions normally. A volunteer runner beside him states he mentioned he was diabetic before the race.
Emergency Contact: Sarah Thornton (Wife) — 0412 874 331

Initial Rapid Assessment

Response: Voice
Airway: Patent. Nil airway obstructions. Nil airway swelling or stridor.
Breathing: Unlaboured. RR 18, adequate depth and rise. Nil audible abnormal breath sounds.
Circulation: Radial pulse rapid and weak. Skin pale, diaphoretic, cool peripheries. Nil visible external bleeding.
Disability: GCS 12 (E3V3M6). Not orientated to time or place. Responds to voice but confused and unable to follow commands consistently.
Exposure: Wearing running gear. Nil visible injuries. Diaphoresis noted across forehead and chest. Medical alert bracelet on left wrist — 'Type 1 Diabetic'.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	96% (RA)	Nil	18	112	104/70	3s	12	4 4 ++	37.1	1.9 mmol/L	–
10 mins	98% (RA)	Nil	14	88	118/76	<2s	15	4 4 ++	37.1	5.4 mmol/L	–

History Taking

Treatment Response

Diagnosis

This patient is suffering from hypoglycaemia secondary to insulin administration, physical exertion, and inadequate carbohydrate intake prior to the event.

Facilitator Triggers — if trainees miss a critical step

! (If the trainee does not perform a BGL within 2 minutes of assessment — patient becomes more drowsy, GCS drops to 10, and begins to resist attempts to communicate. Prompt: 'He seems to be getting worse — what else do you want to check?')
! (If the trainee attempts to give Glucose Oral Gel orally without confirming GCS is 15/15 — patient gags and begins to cough. Prompt: 'He doesn't seem able to swallow safely — what's your next step?')
! (If GCS is confirmed as 15/15 and glucose gel is correctly administered — patient begins to improve within 5 minutes. BGL at recheck is 5.4 mmol/L and GCS returns to 15.)
! (If the trainee fails to reassess BGL and GCS 10 minutes after glucose administration — advise trainee that best practice requires post-treatment reassessment before clearing the patient.)

Treatment Objectives

1 Don appropriate PPE and ensure scene safety at the fun run finish line area.
2 Perform Primary Survey — confirm airway patent, breathing adequate, circulation present with rapid weak radial pulse.
3 Note Medical Alert bracelet — 'Type 1 Diabetic' — on left wrist.
4 Apply pulse oximetry (SpO2 monitoring).
5 Perform Blood Glucose Level (BGL) test — result: 1.9 mmol/L, confirming hypoglycaemia.
6 Perform GCS assessment — GCS 12 (E3V3M6). Patient is NOT GCS 15/15 — oral glucose gel must NOT yet be administered.
7 Record full baseline observations: GCS 12, SpO2 96% (RA), RR 18, BP 104/70, HR 112, CRT 3s, BGL 1.9 mmol/L.
8 Position patient safely — seated or semi-recumbent on the ground, supported. Do NOT allow patient to stand.
9 Continuously reassure patient and bystanders.
10 Reassess GCS as patient is stimulated and responds to voice — if GCS improves to 15/15 with verbal stimulation, proceed to glucose administration.
11 Administer Glucose Oral Gel (Glutose/Glucogel) 15g (entire tube) orally once GCS confirmed as 15/15 — indication: BGL < 4 mmol/L with confirmed conscious state allowing safe oral administration.
12 Instruct patient to hold gel in mouth and swallow — administer in small amounts and confirm patient is tolerating without risk of aspiration.
13 Reassess GCS and BGL at 10 minutes post glucose administration — expected: GCS 15, BGL 5.4 mmol/L.
14 Once GCS 15/15 and BGL > 4 mmol/L confirmed — provide a complex carbohydrate (e.g. sandwich, muesli bar from FAP supplies) to prevent delayed hypoglycaemia.
15 Record repeat observations at 10 minutes: GCS 15, SpO2 98% (RA), RR 14, BP 118/76, HR 88, CRT <2s, BGL 5.4 mmol/L.
16 Contact patient's wife (Sarah Thornton, 0412 874 331) as emergency contact — advise of situation.
17 Strongly encourage transport to hospital via ambulance — advise patient of risk of delayed recurrent hypoglycaemia post-exertion and following insulin dose.
18 Document all observations, BGL readings, treatment administered, and patient response on ePCR.
19 Scenario ends on arrival of ambulance and IMISTAMBO handover.
20 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Hypoglycaemia · Blood Glucose Monitor · Glucose Oral Gel · Primary Survey · Pulse Oximetry · Glasgow Coma Scale (GCS)

How did you go?