Anxious, difficulty in breathing, wheezing, tightness of chest, increased rate of breathing, pale, difficulty in speaking, blue lips.

Reassure the casualty and coach breathing.

Allow the casualty to take their own medication.

Get the casualty in a position most comfortable for them – do not lie them down.

Allow them to use their reliever medication for as long as they need (Blue or Grey = Salbutamol).

A spacer may be improvised with a plastic drinks bottle or paper cup.

If condition does not improve as normal, call your Expedition Supervisor and Emergency Services.

If condition improves, the casualty should continue their medication as normal.

Low Blood Sugar (Glucose-deficient)

Comes on rapidly, tiredness, weakness, sweating, trembling, palpitations, pale, hunger, irritability, confusion, aggressive, emotional swings.

Sugary drinks or sweets if conscious and able to swallow.

If unconscious, crumble 15-20g of glucose tablets and administer between cheek and teeth of casualty, ensuring that no large chunks of tablet cause an airway blockage.

On return to normal, casualty should tell you what they would normally do after hypoglycaemia. They are likely to need more food in the form of complex carbohydrates to stabilise blood glucose.

High Blood Sugar (Insulin-deficient)

Comes on gradually, passing a lot of urine, may be thirsty, headache, weak, dizzy, nauseous, rapid pulse and breathing rate, dehydration, possibly becoming aggressive, gradually becoming drowsy, possibility of fruity smelling breath.

If conscious, get them to test their blood sugar levels and treat for dehydration with an unsweetened drink.

If unconscious, do not inject insulin, call Expedition Supervisor & Emergency Services.

If unsure of hypo or hyperglycaemic in an unconscious casualty, still administer glucose.