Diabetic Emergencies

Diabetes MellitusThe condition brought about by

decreased insulin production, or the inability of the body cells to use insulin properly (which prevents the body’s cells from taking the simple sugar called glucose from the bloodstream)

It is a metabolic disease

Glucose

Body’s basic form of energy Required as fuel for cellular metabolism Brain’s need for glucose parallels its

demand for oxygen

Insulin Hormone Insulin allows Insulin allows sugarsugar to pass from the to pass from the

bloodstreambloodstream into the into the cellscells.. Produced by Islets of Langerhans in the

pancreas

Pancreas

Located in retroperitoneal space

Produces, releases– Digestive enzymes

into duodenum– Insulin, glucagon into

blood

Type I Diabetes No insulin production Takes insulin injections Usually young children or adolescents

affected (juvenile diabetes) Quick onset, progresses rapidly unless

treated.

Type I Diabetes - Warning Signs

Frequent urination and unusual thirst Extreme hunger Rapid weight loss Tire easily, weak and fatigued Irritability Nausea

Type I Diabetes - Treatment

Daily insulin injection– Syringe– Insulin pump

Insulin controls; no cures

Type II Diabetes Most common form (95%) At risk: over 40, overweight, history of

inactivity Inadequate insulin production Gradual/non-dramatic onset. Other life

threatening complications develop before finding (heart disease, kidney, eye problems

Type II Diabetes – Warning Signs

Blurred vision Numbness in legs and arms Slow healing of cuts and bruises Sleepy

Type II Diabetes - Treatment

Diet Oral medications:

• Diabeta, Diabinese, Dymelor, Glucotrol, Micronase, Orinase, Tolinase, Glucophage, Glyburide

Insulin injections as disease progresses

Long Term Complications of Both #1 Cause of blindness in people

between the ages of 20-74 Kidney disease (10%) Amputations – 45% of all non-traumatic

leg and foot amputations Heart disease and stroke Pregnancy (gestational diabetes)

– Risk for not carrying full-term– Higher risk for birth defects

Testing Blood SugarPrepare blood glucose meter and Prepare blood glucose meter and test strip.test strip.

Cleanse skin with alcohol prep.Cleanse skin with alcohol prep.

Use lancet to perform finger stick.Use lancet to perform finger stick.

Apply the blood to test strip.Apply the blood to test strip.

Read blood glucose test results.Read blood glucose test results.

Blood Glucose Readings

80-120 mg/dl Normal

60-80 mg/dl Moderate hypoglycemia

Below 50 mg/dl Severe hypoglycemia

Above 140 mg/dl Hyperglycemia

Question results that are inconsistent with patient’s condition.

Causes of Inaccurate Reading

Meter not calibrated Low batteries in meter Improperly stored or expired test

strip Insufficient blood on test strip

Problems in Diabetes

Blood Sugar Imbalance

Hyperglycemia (diabetic coma)– Diabetic ketoacidosis (DKA)

Hypoglycemia (insulin shock)

Hyperglycemia

Causes– Failure to take insulin– Overeating, eating wrong diet– Stress (fever, infection, emotional stress)

New-onset diabetics usually present with an episode of hyperglycemia

Diabetic Ketoacidosis

Usually Type I diabetic (no insulin) Blood sugar rises Kidneys try to remove excess sugar Urine production increases (polyuria) Patient becomes volume depleted

– Thirst (polydypsia)– Tachycardia– Hypotension– Dry skin, mucous membranes

Diabetic Ketoacidosis

Cells cannot burn sugar; patient experiences hunger (polyphagia)

Cells burn fat as alternative fuel Acidic ketone bodies produced Patient tries to correct acidosis; exhales CO2

Rapid, deep breathing (Kussmaul respirations) Exhaled ketone bodies produce nail-polish

remover or “fruity”/sweet breath odor

Hyperglycemia

Management– Support ABC’s – Treat for hypovolemic shock– Transport– When in doubt, give sugar!

Hypoglycemia

Causes– Insulin overdose– Normal insulin use without eating– Over-exercise

Hypoglycemia

A ltera tions in consc iousness ;S e izures; H ea d a che;

U nusua l B eha v ior

B ra in la ck s a d eq ua te g lucose

P a le ; C ool sk in;S w ea ting ; T achyca rd ia ;Increa sed B P ; N a usea

A d rena l G la nd s re lea se E p inep hr ine

B lood S ug ar F a lls

Pale, cool skin; sweating; nausea; tachycardia

This is why hypoglycemia sometimes is called “Insulin Shock”

Hypoglycemia

Insulin shock isn’t really shock Patient just looks “shocky” because of

epinephrine adrenals are releasing

Hypoglycemia

Can occur in non-diabetics Most common cause =

ETOH on empty stomach A patient is never “just drunk”

Hypoglycemia Management Conscious patient

– Oral Glucose – given orally• Names

– Insta-glucose– Glutose

– Indications• Altered level of consciousness ***• Anxiety• Agitation• Lethargy• Unusual behavior

– History of diabetes or other possible cause of hypoglycemia***

– Able to swallow medication***– When in doubt, give sugar!!!

ContraindicationsUnable to protect airwayUnable to swallow

Hypoglycemia Management

Unconscious patient– Support ABC’s– Get ALS back-up for IV glucose

Ask All Diabetics

Have you eaten today? Have you taken your medication today? When in doubt, give Sugar!

Altered Mental Status

Causes of Altered MentalStatus– Hypoglycemia– Poisoning (including alcohol & drugs) – Infection– Head trauma– Hypoxia

Emergency Care of Altered Mental Status

Secure airway. Ventilate and suction as needed. Transport. When transporting a pt. with

AMS, they should be transported with the head elevated.

Evaluate potential causes.

Treat patient as trauma patient if

injury cannot be ruled out.