First Responder Guide to Diabetic Emergencies
Introduction
Diabetic emergencies—where patients are confused, slurring speech, staggering, or unconscious—are among the most common calls for first responders (police, firefighters, EMTs, paramedics) and distressing events for families and friends. Over 1 million EMS activations occur annually in the U.S. for hypoglycemia alone [2]. These crises, often driven by insulin resistance and hyperinsulinemia, reflect a global epidemic affecting ~50% of adults [1]. Dr. Ben Bikman, a bioenergetics expert, emphasizes that high insulin levels, fueled by frequent carbohydrate consumption, are the root cause, not just blood sugar fluctuations [1]. This First Responder Guide, inspired by Bikman’s insights from The Human Upgrade podcast, equips you to act as an “Insulin Detective.” You’ll learn to stabilize patients, investigate scenes (room, house, kitchen, bathroom), and document findings to inform future care. Designed for coursework and training, this guide empowers first responders and laypeople to manage emergencies and address insulin resistance as a public health crisis.
Understanding Diabetic Emergencies
Diabetic emergencies stem from insulin resistance, where cells resist insulin’s signals, leading to elevated insulin (hyperinsulinemia) and metabolic dysfunction [1]. Bikman notes this affects ~50% of adults, driving diabetes, Alzheimer’s, and heart disease [1]. Emergencies present as:
Hypoglycemia (blood glucose <70 mg/dL): Caused by insulin/medication overdose or post-carb crashes, leading to life-threatening low blood sugar [1, 3].
Hyperglycemia/DKA (blood glucose >250 mg/dL): Driven by chronic insulin resistance, causing dehydration, diabetic ketoacidosis (DKA), or coma [3].
Symptoms:
Hypoglycemia: Tremors, sweating, hunger, anxiety, confusion, slurred speech, staggering (mimicking drunkenness), irritability, seizures, unconsciousness. Drunk-like behaviors often lead to misdiagnosis by police or laypeople [1, 3].
Hyperglycemia/DKA: Lethargy, extreme thirst, frequent urination, dry mouth, nausea, rapid breathing, fruity breath, reduced consciousness [3]. Recognizing these symptoms is critical, as hypoglycemia’s drunk-like presentation (slurred speech, staggering) can be mistaken for intoxication, delaying care [3].
Stabilization Protocol
Objective: Restore consciousness and stabilize the patient. Steps:
Assess Consciousness and Symptoms:
Use the AVPU scale (Alert, Voice, Pain, Unresponsive) [4].
Note symptoms: slurred speech, staggering, tremors (hypoglycemia); fruity breath, rapid breathing (hyperglycemia) [1, 3].
Measure Glucose:
Use a glucometer or continuous glucose monitor (CGM) from the patient’s wrist, arm, or phone app. Hypoglycemia: <70 mg/dL; Hyperglycemia: >250 mg/dL [1].
If unavailable, assume hypoglycemia for drunk-like symptoms or unconsciousness unless DKA signs (fruity breath) are present [3].
Administer Treatment:
Hypoglycemia (Conscious): Give 15g fast-acting carbs (juice, glucose tabs). Recheck glucose after 15 minutes (Rule of 15) [3].
Hypoglycemia (Unconscious): Administer glucagon (1mg nasal or injectable); call 911. Laypeople: provide glucose if patient wakes [3].
Hyperglycemia/DKA: Stabilize with IV fluids (paramedics) and transport. Avoid insulin unless trained [3].
Monitor Vitals: Check pulse, respiration, blood pressure; ensure airway is clear.
Call for Help: Laypeople call 911 immediately; responders request backup if unstable.
Checklist:
Consciousness assessed (AVPU)
Symptoms noted (e.g., slurred speech, fruity breath)
Glucose checked (if possible)
Treatment given (glucagon, glucose, stabilization)
Vitals monitored
911 or backup called
Scene Investigation Protocol
Objective: Identify triggers of the emergency, acting as an “Insulin Detective” per Bikman’s focus on hyperinsulinemia [1]. Steps:
General Scene (Room/House):
Medications/Devices: Locate insulin pens, vials, pumps, oral meds (e.g., metformin), glucometers, CGMs, or glucagon kits. Note recent use (e.g., empty syringes) [1].
Physical Signs: Check neck, armpits, or skin folds for skin tags or acanthosis nigricans (dark, crinkled skin), indicating chronic insulin resistance [1].
Activity Clues: Look for exercise equipment (recent workout?), alcohol bottles (hypoglycemia risk), or stress indicators (bills, work papers) [1].
Environmental Toxins: Note plastic containers, air fresheners, or diesel exhaust exposure (e.g., garage proximity), which Bikman links to insulin resistance [1].
Kitchen:
Food/Drinks: Identify high-carb foods (bread, soda, rice), seed oils (soybean, canola), or fructose sources (juice, candy). Note half-eaten meals or snacking signs (dirty dishes) [1].
Diet Type: Check for low-carb foods (meat, eggs, butter), suggesting ketogenic efforts that affect glucose dynamics [1].
Bathroom:
Medications/Supplements: Look for diabetes meds, corticosteroids, or ketogenic supplements (MCT oil) [1].
Personal Care: Note plastic shampoo bottles or fragranced products (plasticizers) [1].
Sleep/Circadian Clues:
Electronics: Check for phones or TVs left on, indicating blue light exposure that disrupts glucose [1].
Bedroom: Note lack of blackout curtains, linked to poor sleep and cortisol spikes [1].
Medical History:
Documents: Find medical alert bracelets or letters indicating diabetes, PCOS, or Alzheimer’s, which Bikman ties to insulin resistance [1].
Checklist:
Medications/devices noted
Physical signs observed (skin tags, acanthosis nigricans)
Activity clues recorded
Toxins identified
Kitchen foods documented
Bathroom products/meds noted
Sleep/circadian clues observed
Medical history hints collected
Documentation and Reporting Protocol
Objective: Record findings to inform future responders and medical personnel, emphasizing insulin resistance. Steps:
Standard EMS Report:
Include vitals, glucose readings, treatments, and patient history (diabetes type, medications).
Note symptoms (e.g., slurred speech, fruity breath) [4].
Insulin Detective Addendum:
Document medications, physical signs, foods, toxins, and lifestyle clues (e.g., “Found insulin pen, half-eaten pasta, plastic air freshener”) [1].
Highlight insulin resistance indicators (skin tags, high-carb diet).
Recommend insulin testing (fasting insulin, <6 µU/mL ideal) and carb reduction [1].
Layperson Reporting:
Share observations with EMS (e.g., “They ate candy before passing out”) and write notes for doctors.
Data Sharing:
Use the template below for consistency.
Reporting Template:
Diabetic Emergency Report: Insulin Detective Addendum
- Date/Time: [MM/DD/YYYY, HH:MM]
- Patient: [Age, Sex, Diabetes Type if Known]
- Vitals: [Pulse, BP, Respiration]
- Glucose: [mg/dL, if measured]
- Symptoms: [e.g., slurred speech, unconscious]
- Treatment: [e.g., glucagon, glucose]
- Scene Findings:
- Medications/Devices: [e.g., insulin pen, CGM]
- Physical Signs: [e.g., skin tags]
- Food/Drinks: [e.g., soda, bread]
- Toxins: [e.g., plastic bottles]
- Lifestyle: [e.g., late-night phone use]
- Recommendations: [e.g., test fasting insulin, reduce carbs]
- Responder: [Name, Role]
Checklist:
Standard report completed
Insulin Detective addendum added
Observations shared with EMS/doctors
Template used
Insulin Resistance as a Public Health Crisis
Insulin resistance is a global epidemic, akin to drug addiction:
Scale: Affects ~50% of adults, costing $4.3 trillion annually [2].
Carbohydrate Addiction: Frequent carbs (70% of calories) trigger insulin spikes, hunger, and compulsive eating, mirroring addiction’s reward cycles [1, 5]. Responders can document high-carb foods to highlight this.
Responder Irony: ~40% of responders are obese, reliant on carb-heavy fast food, increasing their own insulin resistance risk [6]. Adopting Bikman’s strategies (below) can address this.
Bikman urges responders to act as “Insulin Detectives,” managing emergencies and advocating for insulin testing to combat this crisis [1].
Bikman’s Strategies for Responders and Patients
To prevent emergencies and improve personal health, responders and patients can:
Control Carbohydrates: Avoid starches/sugars (bread, soda). Choose vegetables [1].
Prioritize Protein: Meat, eggs, fish stabilize insulin [1].
Embrace Fats: Butter, olive oil support ketosis [1].
Fasting: Try caloric (no calories) or metabolic (MCT oil) fasting [1].
Resistance Training: Lift weights to boost sensitivity [1].
Cold Immersion: Cold showers burn glucose [1].
Sleep: Avoid blue light at night [1].
Responders can spot these habits (e.g., low-carb foods, gym equipment) in scenes, informing care and adopting them to counter fast food reliance [1].
Training and Application
Training Module:
Duration: 2 hours for responders, 1 hour for laypeople.
Content: Insulin resistance basics, stabilization, scene investigation, reporting, and responder health [1].
Delivery: Workshops with role-playing (mock scenes) and case studies.
Application:
Use this guide in EMS training, police academies, or community workshops.
Integrate the reporting template into electronic health records.
Share with diabetic families to prepare for emergencies.
Take Action
Train as an Insulin Detective: Use this guide in coursework or workshops to master diabetic emergency response.
Stabilize and Investigate: Follow the protocols to save lives and identify insulin resistance triggers.
Document Findings: Use the reporting template to inform future care.
Adopt Bikman’s Strategies: Cut carbs and improve your health to better serve others.
Share: Post on X with #MeasureInsulin or share with colleagues and families.
Connect with Dr. Bikman
Watch the podcast: The Human Upgrade with Dave Asprey [1] (https://www.youtube.com/watch?v=Ta5_bhcZfwY – print this link for editing).
Follow Dr. Bikman on X: @BenBikmanPhD.
Endnotes
Asprey, D. (Host). (2025). Blood sugar hack: The fastest way to burn fat, optimize hormones & reverse disease [Video podcast episode]. In The Human Update. Available at: https://www.youtube.com/watch?v=Ta5_bhcZfwY (print this link for editing).
Centers for Disease Control and Prevention. (2023). National diabetes statistics report. Available at: https://www.cdc.gov/diabetes (print this link for editing).
American Diabetes Association. (2023). Standards of medical care in diabetes—2023. Diabetes Care, 46(Suppl. 1), S1-S291.
National Registry of Emergency Medical Technicians. (2023). EMT national training curriculum.
Ludwig, D. S. (2018). The carbohydrate-insulin model of obesity: Beyond “calories in, calories out.” JAMA Internal Medicine, 178(8), 1098-1103.
Flegal, K. M., et al. (2023). Prevalence of obesity among U.S. adults. JAMA, 329(12), 1023-1030.