Wilderness Medical Society Clinical Practice Guidelines for Diabetes Management discusses treatment for patients presenting with severe hypoglycemia. Backcountry guidelines state that for a patient that can swallow, 15 – 20 grams of sugar should be administered to the patient through oral administration. Most wilderness medical schools instruct students that best practice treatment for patients who are unable to swallow or are unresponsive is to place the patient in the recovery position. Mix 15 – 20 grams of sugar with just enough water to create a paste.  Using your gloved fingers, rub the sugar paste into the patient’s gums. 

You may find during the primary or secondary assessment that your patient has a Glucagon emergency injector kit which requires the caregiver to deliver an intramuscular injection to the patient. You should familiarize yourself with the instructions for use if you have a family member or you are leading an outdoor group where a member carries an emergency injector.

However, you may find the patient has a Glucagon intranasal delivery device. One that you may see currently advertising on television is Eli Lilly’s BAQSIMI™.  Lilly’s website states: “BAQSIMI is a prescription medicine used to treat very low blood sugar (severe hypoglycemia) in people with diabetes ages 4 years and above.” “BAQSIMI should be used when someone is having a low blood sugar emergency, where the person is unable to eat or drink and needs help from someone else.”

BAQSIMI is administered by inserting the applicator tip into one nostril and pressing the device plunger all the way in until the green line is no longer showing. The dose does not need to be inhaled.

Instruction for Use: PDF download and video instructions. 

For patient that is presenting with severe hypoglycemia, you should activate the EMS System and the patient requires immediate evacuation to the hospital.

The BAQSIMI and Got Your BAQ designs are trademarks of Eli Lilly and Company.