Low Blood Sugar and Diabetic Emergencies at Work
Why this matters
Low blood sugar comes on fast, in minutes, and it takes away the judgment of the person it is happening to. A tech who takes insulin, skips lunch to make the next stop and then spends an hour in a hot attic is a textbook setup. To a coworker the person can look drunk, angry, confused or just off, and the risk is that everyone treats it as a mood or a heat problem until the person cannot swallow. The fix, when they are still awake, is a few ounces of juice. The window for that fix is short.
This card covers what you see, what you give, when you call 911, and the conversation worth having with a diabetic coworker before any of it happens. It follows American Red Cross, American Heart Association and American Diabetes Association guidance. It is not training; a hands-on first aid course is what makes a responder.
What low blood sugar is
Blood sugar (glucose) is the brain's fuel. People with diabetes who take insulin or certain oral medications can have their level drop too far, especially after a missed or late meal, heavy physical work, heat, or a dose that did not match the day. The American Diabetes Association defines low blood sugar, called hypoglycemia, as a reading below 70 mg/dL on a glucose meter. Most people with diabetes carry a meter or wear a continuous glucose monitor (CGM), a small sensor on the arm or belly that reads to a phone or receiver and often alarms when the level drops.
A person without diabetes can also go low after long hours of heavy work without eating, though it is less common and usually milder.
What you see
Signs vary from person to person, and the person's own description of their early signs is the most reliable guide. Common ones:
- Early: shaking, sweating, a pounding or fast heartbeat, sudden hunger, anxiety or irritability, pale skin, dizziness.
- Developing: confusion, slow or slurred speech, poor coordination, blurred vision, acting out of character, stubbornly refusing help.
- Severe: unable to follow simple instructions, unable to swallow, a seizure, unresponsive.
It looks like other things. Slurred speech and stumbling look like intoxication. Confusion and sweating in an attic look like heat illness (see related: Heat Illness Prevention (OSHA NEP)). A person who is low may insist they are fine and get angry when pressed, because the low is affecting their thinking. Treat a coworker known to have diabetes who suddenly acts wrong as low until proven otherwise.
The fix while they are awake and can swallow
If the person is awake, can sit up and can swallow, give fast sugar. The American Diabetes Association calls this the 15-15 rule:
- Give about 15 grams of fast-acting sugar. Four ounces (half a cup) of fruit juice or regular, non-diet soda; three or four glucose tablets; or a tablespoon of sugar or honey. Their own supply, if they carry it, is first choice.
- Wait 15 minutes, sitting down, out of the heat. If they have a meter, they check it at 15 minutes.
- Repeat if they are still low: still symptomatic, or a reading still below 70 mg/dL.
- Once they are back in range, food. A snack or meal with carbohydrate and protein keeps the level from dropping again.
Use sugar that acts fast. Chocolate, a candy bar with nuts, or a protein bar raises blood sugar slowly because the fat and protein slow it down. Diet soda has no sugar at all. Juice or a regular soda from the customer's fridge, asked for politely, is a legitimate thing to need.
When you are not sure whether it is low blood sugar, heat, or something else, and the person is awake and can swallow, give the sugar anyway. If the problem was not low blood sugar, a few ounces of juice does not make it worse. If it was, you have fixed it.
When to call 911
Call 911 when the person:
- cannot swallow, or is too drowsy or confused to drink on command;
- is unresponsive, or has a seizure;
- is not improving after two rounds of the 15-15 rule;
- is having trouble breathing or has chest pain;
- or you cannot tell what is wrong and they are getting worse.
If they cannot swallow, give nothing by mouth. Juice poured into the mouth of someone who cannot protect their airway can be inhaled into the lungs. Lay them on their side in the recovery position so their airway stays open, and stay with them.
If they carry emergency glucagon (a hormone that raises blood sugar, carried by many insulin users for exactly this) and have shown you how to use it, use it the way they showed you. If they have not, tell the dispatcher it is there and follow the dispatcher's instructions. Do not give insulin; that is the drug that lowers blood sugar.
If they stop breathing normally, start CPR and use the AED. See related: First Aid + AED on the Jobsite.
Ask before it happens
The single most useful thing you can do for a diabetic coworker is ask them, privately and in advance, what they want you to do. People who manage diabetes usually know exactly what their lows look like and what they want done, and many are glad someone asked.
LEAD: You mentioned you're on insulin. If you ever
go low on a job with me, what do you want me
to do?
TECH: I usually feel it first. Shaky, sweaty. My
CGM buzzes under 70. Glucose tabs are in the
left door pocket.
LEAD: And if you're not making sense?
TECH: Then I'm low, not tired. Make me drink juice
even if I say I'm fine. If I can't drink it,
call 911. Glucagon's in my lunch bag.
LEAD: Can you show me how it works?
TECH: Sure. Monday, before we roll.
LEAD: Okay. And I won't mention it to anyone else
unless you want me to.
Four things came out of that: the early signs, where the sugar is, what to do when the tech's own judgment goes, and where the glucagon is. The lead also said he would keep it private.
Keep it voluntary and private. A shop cannot require someone to disclose a diabetes diagnosis. The federal disability law (the Americans with Disabilities Act, which reaches employers with 15 or more employees; many states reach smaller employers with their own laws) requires employee medical information the employer holds to be kept confidential. It can also require reasonable accommodations, such as breaks to eat or test, or keeping supplies on the truck. This is not legal advice; ask your own attorney before writing a policy. The practical rule is simple: ask, do not demand, and do not repeat what you are told.
A worked case: an August attic
A two-person HVAC crew is replacing an attic air handler in August. The lead has done the conversation above with the helper, who takes insulin and wears a CGM. They skipped lunch at noon to keep the job on schedule. At 2:30 pm the attic is far hotter than the outdoor temperature.
2:30. The helper's CGM vibrates. He ignores it and keeps working. The lead notices he is fumbling the screws on the cabinet panel and repeating himself.
2:32. The lead says, "You're low. Come down." The helper says he is fine and just hot. The lead recognizes both things from the conversation: he is not making sense, and he said to treat that as low. He insists, and they climb down together, the lead going first on the ladder so the helper is not the last one down unsupervised.
2:35. In the air-conditioned living room, the helper's CGM reads 54 mg/dL, below the 70 line. He is sweating heavily and can sit up and swallow. Round one: the lead gets the glucose tablets from the truck door pocket, and the helper chews four, which is in the 15-gram range for most tablets. He sits on the floor with a bottle of water.
2:50. Fifteen minutes later he reads 63 mg/dL. That is up from 54, but still below 70, and he still feels shaky. Round two: the homeowner offers a glass of orange juice, and the lead measures about 4 ounces.
3:05. Fifteen minutes after round two, he reads 92 mg/dL, over 70. The shaking has stopped and he is speaking normally. He eats a sandwich from the cooler.
3:20. The lead decides the helper does not go back into the attic today, and that the lead drives the truck back to the shop. Two lows in a row in heat on an empty stomach is a day to stop, and driving after a low is the helper's clinician's call, not a work-schedule call. The lead spends ten minutes refitting the cabinet panel he can reach from the hatch, with the helper eating in the living room within earshot, then calls the office to move the remaining work to the next morning.
What would have changed it. If at 2:35 the helper had been too drowsy to chew or drink, the lead puts nothing in his mouth, lays him on his side, calls 911 and tells the dispatcher there is glucagon in the lunch bag. If at 2:30 he had passed out in the attic rather than climbing down, the problem is now also getting help to a person who cannot get out of a hot space. See related: Fainting and Collapse in Attics and Crawlspaces.
The prevention the case points to. The low started with a skipped lunch. The schedule change that would have prevented it is a 15-minute food break before a hot attic, not after it.
High blood sugar, briefly
Very high blood sugar develops over hours or days, not minutes. Signs include extreme thirst, frequent urination, nausea, fruity-smelling breath and deep, rapid breathing. It is a medical emergency when the person is vomiting, confused or breathing hard, and the answer is 911, not sugar. You do not need to tell the two apart to act: the fast sugar rule applies to a person who is awake and can swallow, and 911 applies to everyone else.
References
- American Diabetes Association, hypoglycemia and the 15-15 rule
- American Red Cross and American Heart Association Guidelines for First Aid, diabetic emergencies
- Americans with Disabilities Act and EEOC guidance on diabetes in the workplace and medical confidentiality
- See related: Heat Illness Prevention (OSHA NEP)
- See related: How to Help a Coworker Having a Seizure