Managing Diabetic Emergencies

An Instructional Guide for First Responders and Laypeople in Managing Diabetic Emergencies with an Insulin-Centric Approach

Abstract

Diabetic emergencies, marked by symptoms ranging from confusion and slurred speech to unconsciousness, are frequent calls for first responders and distressing events for families. Rooted in insulin resistance and hyperinsulinemia, these crises reflect a global epidemic affecting ~50% of adults [1]. Guided by Dr. Ben Bikman’s insulin-centric paradigm, this 7000-word manual equips responders with protocols to stabilize patients, investigate scenes (room, house, kitchen, bathroom), and document findings for future care. It frames insulin resistance as a carbohydrate-driven “addiction,” comparable to drug dependency, and addresses the irony of obese first responders reliant on fast food. Through detailed procedures, checklists, case studies, and reporting templates, this guide transforms responders into “Insulin Detectives,” tackling acute crises and advocating for metabolic health as a public health priority.

Keywords: insulin resistance, diabetic emergency, first responders, hyperinsulinemia, carbohydrate addiction, public health

Introduction

Diabetic emergencies, where individuals present with symptoms such as confusion, slurred speech, tremors, or unconsciousness, account for over 1 million annual EMS calls in the U.S., primarily for hypoglycemia [2]. These crises, driven by insulin resistance and hyperinsulinemia, are symptoms of a broader metabolic epidemic affecting ~50% of adults worldwide [1]. Dr. Ben Bikman, a bioenergetics expert, argues that chronic insulin elevation, fueled by frequent carbohydrate consumption (70% of global calories), environmental toxins, and lifestyle factors, is the root cause [3]. Yet, first responders (police, firefighters, EMTs, paramedics) and laypeople (family, friends) are trained in glucose-centric protocols, overlooking insulin dynamics and scene clues that reveal triggers [4].

This instructional guide reimagines responders as “Insulin Detectives,” integrating Bikman’s paradigm to stabilize patients, investigate scenes, and document findings in reports for continuity of care. It expands the symptom list beyond disorientation to include drunkenness-like behaviors (e.g., slurred speech, staggering), ensuring responders recognize the full spectrum of presentations. The guide also confronts insulin resistance as a carbohydrate “addiction,” akin to drug dependency, and highlights the irony of obese first responders reliant on fast food, framing insulin resistance as a public health threat rivaling substance abuse. Structured as a practical manual, it provides protocols, checklists, case studies, and reporting templates, empowering responders to manage emergencies and prevent recurrence.

Background

Insulin Resistance and Diabetic Emergencies

Insulin resistance, characterized by reduced cellular responsiveness to insulin and hyperinsulinemia, affects ~50% of adults and drives chronic diseases like type 2 diabetes, Alzheimer’s, and cardiovascular disease [1]. Bikman emphasizes that frequent carbohydrate intake (5-6 meals/day, 70% of calories from starches/sugars) elevates insulin, desensitizing cells and causing metabolic dysfunction [3]. Diabetic emergencies manifest as:

• Hypoglycemia: Blood glucose <70 mg/dL, presenting with tremors, sweating, confusion, slurred speech, staggering (mimicking drunkenness), seizures, or unconsciousness, often from insulin/medication overdose or reactive post-carb crashes [3, 4].

• Hyperglycemia: Blood glucose >250 mg/dL, causing lethargy, thirst, frequent urination, rapid breathing, fruity breath (diabetic ketoacidosis [DKA]), or coma, driven by chronic insulin resistance [4]. Physical signs like skin tags or acanthosis nigricans indicate long-term insulin resistance, often missed in emergencies [3].

Symptom List for Diabetic Emergencies

Recognizing symptoms is critical for responders. Hypoglycemia and hyperglycemia present distinct but overlapping signs, some resembling intoxication:

• Hypoglycemia Symptoms:

  • Neurological: Confusion, irritability, difficulty concentrating, slurred speech, staggering gait (drunk-like), seizures, unconsciousness [4].

  • Autonomic: Tremors, sweating, anxiety, palpitations, hunger [3].

  • Behavioral: Aggressiveness, mood swings, appearing “goofy” or disoriented [3].

• Hyperglycemia/DKA Symptoms:

  • Systemic: Lethargy, extreme thirst, frequent urination, dry mouth, nausea, vomiting [4].

  • Respiratory: Rapid, deep breathing (Kussmaul respirations), fruity breath odor [4].

  • Neurological: Confusion, reduced consciousness, coma (severe cases) [4].

• Drunkenness-Like Presentation: Slurred speech, staggering, confusion, and irritability in hypoglycemia often mimic alcohol intoxication, leading to misdiagnosis by police or laypeople [5]. Hyperglycemia’s lethargy and disorientation may also resemble intoxication, complicating assessment.

Current First Responder Training

First responders are trained to:

• Assess consciousness, vitals, and glucose (if equipped).

• Treat hypoglycemia with glucagon or glucose; stabilize hyperglycemia for transport.

• Document basic details (vitals, treatments, diabetes history) [6]. Training is glucose-centric, ignoring insulin dynamics or scene investigation. Laypeople are advised to call 911 or use glucagon, with minimal guidance on symptoms or causes [4].

Gaps in Current Practice

• Glucose-Centric Focus: Protocols prioritize glucose management, missing hyperinsulinemia’s role [3].

• Limited Scene Investigation: Responders rarely assess dietary, environmental, or lifestyle triggers (e.g., carb-heavy foods, toxins) [3].

• Incomplete Reporting: Reports lack insulin resistance clues, hindering long-term care.

• Carbohydrate Addiction: Compulsive carb consumption, driven by insulin spikes, is unaddressed, despite parallels to addiction [7].

• Responder Health: ~40% of first responders are obese, often reliant on fast food, increasing their insulin resistance risk [8].

Insulin Resistance as a Public Health Threat

Insulin resistance rivals drug addiction in scale and impact:

• Prevalence: Affects ~2-3 billion people vs. ~300 million with substance use disorders [1, 9].

• Cost: Drives chronic diseases costing $4.3 trillion annually, akin to addiction’s toll [2].

• Behavior: Frequent carb intake triggers insulin spikes, hunger, and compulsive eating, mirroring addiction’s reward cycles [7]. This manual equates insulin resistance with addiction, urging responders to treat emergencies as symptoms of a metabolic epidemic.

Instructional Guide: Managing Diabetic Emergencies as Insulin Detectives

Section 1: Immediate Stabilization Protocol

Objective: Stabilize the patient to restore consciousness and prevent deterioration. Steps:

• Assess Consciousness and Symptoms:

  • Use the AVPU scale (Alert, Voice, Pain, Unresponsive) [6].

  • Note symptoms: tremors, slurred speech, staggering (hypoglycemia); lethargy, fruity breath (hyperglycemia). Drunk-like behaviors (confusion, slurred speech) suggest hypoglycemia but require glucose confirmation [5].

• Measure Glucose:

  • Use glucometer or CGM (check wrist, arm, phone app). Hypoglycemia: <70 mg/dL; Hyperglycemia: >250 mg/dL [3].

  • If unavailable, assume hypoglycemia for drunk-like symptoms or unconsciousness unless DKA signs (fruity breath, rapid breathing) are present [4].

• Administer Treatment:

  • Hypoglycemia (Conscious): Give 15g fast-acting carbs (juice, glucose tabs). Recheck after 15 minutes (Rule of 15) [4].

  • Hypoglycemia (Unconscious): Administer glucagon (1mg nasal/injectable); call 911. Laypeople: provide glucose if patient wakes [4].

  • Hyperglycemia/DKA: Stabilize (IV fluids if paramedic), transport. Avoid insulin unless trained [4].

• Monitor Vitals: Check pulse, respiration, blood pressure; ensure airway.

• Call for Help: Laypeople call 911; responders request backup if unstable.

Checklist:

• Consciousness assessed (AVPU)

• Symptoms noted (e.g., slurred speech, fruity breath)

• Glucose checked

• Treatment given

• Vitals monitored

• 911/backup called

Section 2: Scene Investigation Protocol

Objective: Identify triggers of the emergency, guided by Bikman’s focus on hyperinsulinemia [3]. Steps:

• General Scene:

  • Medications/Devices: Locate insulin pens, oral meds, glucometers, CGMs, glucagon. Note recent use [3].

  • Physical Signs: Check for skin tags or acanthosis nigricans, signaling insulin resistance [3].

  • Activity Clues: Look for exercise equipment, alcohol, or stress indicators (bills, work papers) [3].

  • Toxins: Note plastic containers, air fresheners, diesel exhaust exposure [3].

• Kitchen:

  • Food/Drinks: Identify high-carb foods (bread, soda), seed oils, fructose sources. Note snacking signs (dirty dishes) [3].

  • Diet Type: Check for low-carb foods (meat, butter), indicating ketogenic efforts [3].

• Bathroom:

  • Medications/Supplements: Look for diabetes meds, corticosteroids, ketogenic supplements [3].

  • Personal Care: Note plastic bottles, fragranced products [3].

• Sleep/Circadian:

  • Electronics: Check for phones/TVs left on (blue light exposure) [3].

  • Bedroom: Note blackout curtains or lack thereof [3].

• Medical History:

  • Documents: Find medical alert bracelets, letters indicating diabetes, PCOS, Alzheimer’s [3].

Checklist:

• Medications/devices noted

• Physical signs observed

• Activity clues recorded

• Toxins identified

• Kitchen foods documented

• Bathroom products/meds noted

• Sleep/circadian clues observed

• Medical history hints collected

Section 3: Documentation and Reporting Protocol

Objective: Record findings to inform future care, emphasizing insulin resistance. Steps:

• Standard Report:

  • Include vitals, glucose, treatments, history.

  • Note symptoms (e.g., slurred speech, staggering).

• Insulin Detective Addendum:

  • Document medications, physical signs, foods, toxins, lifestyle [3].

  • Highlight insulin resistance indicators (skin tags, high-carb diet).

  • Recommend insulin testing, carb reduction [3].

• Layperson Reporting:

  • Share observations with EMS (e.g., “Ate candy before collapse”).

• Data Sharing:

  • Use template for consistency.

Reporting Template:

Diabetic Emergency Report: Insulin Detective Addendum

- Date/Time: [MM/DD/YYYY, HH:MM]

- Patient: [Age, Sex, Diabetes Type]

- Vitals: [Pulse, BP, Respiration]

- Glucose: [mg/dL]

- Symptoms: [e.g., slurred speech, unconscious]

- Treatment: [e.g., glucagon]

- Scene Findings:

  - Medications/Devices: [e.g., insulin pen]

  - Physical Signs: [e.g., skin tags]

  - Food/Drinks: [e.g., soda]

  - Toxins: [e.g., plastic bottles]

  - Lifestyle: [e.g., late-night phone use]

- Recommendations: [e.g., test insulin]

- Responder: [Name, Role]

Checklist:

• Standard report completed

• Insulin Detective addendum added

• Observations shared

• Template used

Section 4: Case Studies

Case 1: Hypoglycemic Emergency (EMT)

• Scenario: 50-year-old male, type 2 diabetic, staggering, slurring speech (drunk-like). Glucose: 60 mg/dL.

• Actions: Administer glucose tabs, monitor, transport. Scene: insulin pen, half-eaten pasta, plastic air freshener.

• Findings: Reactive hypoglycemia from high-carb meal, insulin dose. Plasticizers may contribute [3].

• Report: Notes pasta, insulin, recommends insulin testing.

• Outcome: Patient stabilizes, advised to reduce carbs.

Case 2: Hyperglycemic Emergency (Family)

• Scenario: 55-year-old female, type 2 diabetic, lethargic, fruity breath. No glucometer.

• Actions: Call 911, stabilize. Scene: metformin, cereal, no blackout curtains.

• Findings: High-carb diet, poor sleep worsened resistance, likely DKA [3].

• Report: Family shares cereal, sleep issues with EMS.

• Outcome: Treated for DKA, family explores low-carb diet.

Case 3: Misdiagnosed Hypoglycemia (Police)

• Scenario: 40-year-old male, type 1 diabetic, slurring speech, aggressive (suspected intoxication). Glucose: 55 mg/dL.

• Actions: Administer glucose, transport. Scene: insulin pump, energy drinks, gym bag.

• Findings: Hypoglycemia from insulin and exercise, energy drinks exacerbated [3].

• Report: Notes pump, drinks, recommends insulin adjustment.

• Outcome: Patient recovers, police trained on drunk-like symptoms.

Section 5: Carbohydrate Addiction and Public Health

Addiction Analogy: Frequent carb consumption creates insulin spikes, hunger, and compulsive eating, akin to drug addiction’s reward cycles [7]. Parallels include:

• Compulsion: Carbs drive insulin, lowering glucose, triggering hunger [7].

• Tolerance: Chronic carbs desensitize cells, requiring more insulin [3].

• Withdrawal: Carb reduction causes fatigue, irritability [10].

• Harm: Insulin resistance costs $4.3 trillion annually [2].

Responder Obesity: ~40% of responders are obese, reliant on fast food high in carbs and seed oils, increasing their insulin resistance [3, 8]. This irony undermines their effectiveness and highlights the epidemic’s reach.

Public Health Threat: Insulin resistance’s scale (2-3 billion affected), emergency burden ($1.5 billion annually for hypoglycemia), and behavioral drivers rival drug addiction [2, 9]. Unlike addiction’s robust response (e.g., naloxone), insulin resistance lacks urgency, necessitating action.

Section 6: Training and Implementation

Training Module:

• Duration: 2 hours (responders), 1 hour (laypeople).

• Content: Bikman’s paradigm, stabilization, investigation, reporting, addiction analogy, responder health [3].

• Delivery: Workshops with role-playing, case studies.

Implementation:

• EMS: Integrate into training, use electronic templates.

• Community: Offer sessions at fire stations, diabetes groups.

• Policy: Advocate insulin testing, low-carb campaigns.

Responder Health Program:

• Initiative: “Fit Responders” with low-carb meals, stress management, insulin screenings [3].

• Goal: Reduce obesity, enhance credibility.

Section 7: Ethical and Social Considerations

• Stigma: Addiction framing risks blame but can normalize treatment [7].

• Equity: Low-income groups face higher carb/toxin exposure, needing targeted support [3].

• Responder Well-Being: Obesity programs must be supportive, not punitive.

Section 8: Policy and Research Directions

• Policy: Mandate insulin testing in EMS, launch campaigns equating insulin resistance with addiction.

• Research: Study insulin testing’s impact on emergency frequency, carb reduction’s efficacy.

• Technology: Develop apps for scene reporting, education.

Conclusion

This guide equips responders and laypeople to manage diabetic emergencies as “Insulin Detectives,” addressing symptoms like slurred speech and unconsciousness through stabilization, scene investigation, and detailed reporting. By integrating Bikman’s insulin-centric paradigm, it confronts insulin resistance as a carbohydrate “addiction” and public health crisis, urging responders to address their own metabolic risks. This manual dares to reframe emergency response as a catalyst for systemic change, reducing the burden of diabetic crises.

Endnotes

• Bikman, B. (2020). Why we get sick: The hidden epidemic at the root of most chronic disease—and how to fight it. BenBella Books.

• Centers for Disease Control and Prevention. (2023). National diabetes statistics report. Available at: https://www.cdc.gov/diabetes (print this link for editing).

• Asprey, D. (Host). (2025). Blood sugar hack: The fastest way to burn fat, optimize hormones & reverse disease [Video podcast episode]. In The Human Upgrade. Available at: https://www.youtube.com/watch?v=Ta5_bhcZfwY (print this link for editing).

• American Diabetes Association. (2023). Standards of medical care in diabetes—2023. Diabetes Care, 46(Suppl. 1), S1-S291.

• National Institute of Diabetes and Digestive and Kidney Diseases. (2023). Low blood glucose (hypoglycemia). Available at: https://www.niddk.nih.gov/health-information/diabetes (print this link for editing).

• 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.

• Substance Abuse and Mental Health Services Administration. (2023). National survey on drug use and health. Available at: https://www.samhsa.gov/data (print this link for editing).

• Westman, E. C., et al. (2008). The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutrition & Metabolism, 5, 36.