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Characterized by absent or diminished insulin secretion by the pancreas, or by defects of insulin receptors in the body, diabetes is the most common endocrine disorder. Hypoglycemia is the most common endocrine emergency [1]. Type 1 diabetes occurs when pancreatic beta cells are destroyed, removing the body’s only insulin‐producing mechanism. Typically occurring in children and adolescents, type 1 diabetes accounts for 5%‐10% of diabetes cases. Affected individuals require exogenous insulin administration to survive. Type 2 diabetes is more common, responsible for 90%‐95% of all diabetes diagnoses. Rather than a defect of insulin production, type 2 diabetes is characterized by insulin resistance at the cellular level and gradual failure of pancreatic production of insulin. Type 2 diabetes occurs predominantly in older adults and is associated with physical inactivity, obesity, and a history of gestational diabetes. Women who experience gestational diabetes carry a 35%‐60% chance of developing type 2 diabetes over the next 5 to 10 years [2]. Diabetes remains a major cause of coronary heart disease and stroke, and it is the seventh leading cause of death in the United States.

Diabetes is a chronic disease that, at present, has no cure. In 2018, 34.2 million persons in the United States were living with diabetes, representing 10.5% of the U.S. population. Of these, 26.9 million people had known diagnoses of diabetes, and the remaining 7.3 million had unrecognized and untreated diabetes. Additionally, 51 million people aged 40 to 74 years had impaired glucose tolerance, impaired fasting glucose, or both [3]. Diabetes occurs more frequently in Native American, Hispanic, and African American populations.

One‐and‐a‐half million new cases of diabetes are diagnosed annually, and diabetes‐related visits to U.S. emergency departments (EDs) totaled 16 million in 2016 [3, 4]. Approximately 235,000 ED visits were for hypoglycemia; 22.3% of which resulted in hospital admission. In the same interval, there were approximately 203,000 ED visits for diabetic ketoacidosis (DKA) [3].

The cost of diabetes in the United States is staggering. In 2017, an estimated $327 billion dollars were spent annually for direct and indirect medical costs [3]. After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than expenditures in the absence of diabetes [5].

As the prevalence of diabetes increases, clinicians are more likely to encounter patients experiencing hypoglycemic and hyperglycemic emergencies. Diabetes‐related EMS responses are greater among young adults, males, and non‐Hispanic black people with diabetes. However, more than one third of patients are not transported to the ED for further care [6].

While most EMS responses for diabetic emergencies are for hypoglycemia, both hypoglycemia and hyperglycemia can result in fatal outcomes [1]. Thus, the ability of EMS clinicians to recognize and promptly initiate appropriate treatment for diabetic emergencies is crucial.