Red flags — act immediately

Severe hypoglycemia — confusion, seizure, or unresponsiveness → give glucagon per order FIRST and activate EMS if the patient cannot safely take oral carbohydrate or does not rapidly improve.

Diabetic ketoacidosis or hyperosmolar state — very high glucose with dehydration, deep rapid breathing or a fruity odor, and altered mentation → activate EMS.

Positive ketones with hyperglycemia and vomiting or an inability to keep fluids down → notify urgently; impending ketoacidosis.

A pattern persistently outside the ordered individualized range, or a regimen no longer controlling glucose → notify for a regimen adjustment.

Recurrent hypoglycemia or new hypoglycemia unawareness → notify; the target or regimen likely needs adjustment.

A new diabetic-foot lesion or new loss of protective sensation → offload and notify; high amputation risk (cross-reference Wounds and Touch/Sensation).