Blood sugar should be checked in runners with sign and symptoms consistent with hypoglycemia which may include altered mental status and unresponsiveness.

If the runner is unresponsive with a blood sugar of < 55 mg/dl:

• Give Glucagon 1 mg SC/IM
• Start D5NS
• Prepare for transport to the emergency department

If the runner has altered mental status with a blood sugar < 55 mg/dl

• Give 1 ampule of D50W
• Start D5NS
• Recheck blood sugar in 10-15 minutes
  • If > 55 mg/dl and improving mental status observe and manage as appropriate
  • If < 55 mg/dl repeat 1 ampule of D50W and prepare for transport

If the runner has normal mental status:

• Give 15-30 mg of oral glucose
• Recheck blood sugar in 10-15 minutes
  • If > 55 mg/dl and asymptomatic:  encourage PO intake and D/C when stable
  • If < 55 mg/dl and asymptomatic: repeat the oral glucose challange
  • If < 55 mg/dl and symptomatic give 1 ampule of D50W and prepare for transport
• Prepare for transport if not responsive to treatment measures