1. Diabetic Emergencies

2. Diabetes Mellitus The 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

3. Glucose nBnBody’s basic form of energy nRnRequired as fuel for cellular metabolism nBnBrain’s need for glucose parallels its demand for oxygen

4. Insulin n Hormone n Insulin allows sugar to pass from the bloodstream into the cells. n Produced by Islets of Langerhans in the pancreas

5. Pancreas n Located in retroperitoneal space n Produces, releases –Digestive enzymes into duodenum –Insulin, glucagon into blood

6. Type I Diabetes n No insulin production n Takes insulin injections n Usually young children or adolescents affected (juvenile diabetes) n Quick onset, progresses rapidly unless treated.

7. Type I Diabetes- Warning Signs n Frequent urination and unusual thirst n Extreme hunger n Rapid weight loss n Tire easily, weak and fatigued n Irritability n Nausea

8. Type I Diabetes - Treatment n Daily insulin injection –Syringe –Insulin pump n Insulin controls; no cures

9. Type II Diabetes n Most common form (95%) n At risk: over 40, overweight, history of inactivity n Inadequate insulin production n Gradual/non-dramatic onset. Other life threatening complications develop before finding (heart disease, kidney, eye problems

10. Type II Diabetes – Warning Signs n Blurred vision n Numbness in legs and arms n Slow healing of cuts and bruises n Sleepy

11. Type II Diabetes - Treatment n Diet n Oral medications: Diabeta, Diabinese, Dymelor, Glucotrol, Micronase, Orinase, Tolinase, Glucophage, Glyburide n Insulin injections as disease progresses

12. Long Term Complications of Both n #1 Cause of blindness in people between the ages of 20-74 n Kidney disease (10%) n Amputations – 45% of all non-traumatic leg and foot amputations n Heart disease and stroke n Pregnancy (gestational diabetes) –Risk for not carrying full-term –Higher risk for birth defects

13. Testing Blood Sugar Prepare blood glucose meter and test strip.

14. Cleanse skin with alcohol prep.

15. Use lancet to perform finger stick.

16. Apply the blood to test strip.

17. Read blood glucose test results.

18. Blood Glucose Readings 80-120 mg/dl Normal 60-80 mg/dlModerate hypoglycemia Below 50 mg/dl Severe hypoglycemia Above 140 mg/dlHyperglycemia Question results that are inconsistent with patient’s condition.

19. Causes of Inaccurate Reading n Meter not calibrated n Low batteries in meter n Improperly stored or expired test strip n Insufficient blood on test strip

20. Problems in Diabetes

21. Blood Sugar Imbalance n Hyperglycemia (diabetic coma) –Diabetic ketoacidosis (DKA) n Hypoglycemia (insulin shock)

22. Hyperglycemia n Causes –Failure to take insulin –Overeating, eating wrong diet –Stress (fever, infection, emotional stress) New-onset diabetics usually present with an episode of hyperglycemia

23. Diabetic Ketoacidosis n Usually Type I diabetic (no insulin) n Blood sugar rises n Kidneys try to remove excess sugar n Urine production increases (polyuria) n Patient becomes volume depleted –Thirst (polydypsia) –Tachycardia –Hypotension –Dry skin, mucous membranes

24. Diabetic Ketoacidosis n Cells cannot burn sugar; patient experiences hunger (polyphagia) n Cells burn fat as alternative fuel n Acidic ketone bodies produced n Patient tries to correct acidosis; exhales CO 2 n Rapid, deep breathing (Kussmaul respirations) n Exhaled ketone bodies produce nail-polish remover or “fruity”/sweet breath odor

25. Hyperglycemia nMnManagement –S–Support ABC’s –T–Treat for hypovolemic shock –T–Transport –W–When in doubt, give sugar!

26. Hypoglycemia n Causes –Insulin overdose –Normal insulin use without eating –Over-exercise

27. Hypoglycemia Pale, cool skin; sweating; nausea; tachycardia This is why hypoglycemia sometimes is called “Insulin Shock”

28. Hypoglycemia n Insulin shock isn’t really shock n Patient just looks “shocky” because of epinephrine adrenals are releasing

29. Hypoglycemia n Can occur in non-diabetics n Most common cause = ETOH on empty stomach n A patient is never “just drunk”

30. Hypoglycemia Management n 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!!! Contraindications  Unable to protect airway  Unable to swallow

31. Hypoglycemia Management n Unconscious patient –Support ABC’s –Get ALS back-up for IV glucose

32. Ask All Diabetics n Have you eaten today? n Have you taken your medication today? n When in doubt, give Sugar!

33. Altered Mental Status n Causes of Altered Mental Status –Hypoglycemia –Poisoning (including alcohol & drugs) –Infection –Head trauma –Hypoxia

34. Emergency Care of Altered Mental Status n Secure airway. n Ventilate and suction as needed. n Transport. When transporting a pt. with AMS, they should be transported with the head elevated. n Evaluate potential causes. Treat patient as trauma patient if injury cannot be ruled out.