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Diabetic Emergencies
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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
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Glucose
Body’s basic form of energy Required as fuel for cellular metabolism Brain’s need for glucose parallels its
demand for oxygen
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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
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Pancreas
Located in retroperitoneal space
Produces, releases– Digestive enzymes
into duodenum– Insulin, glucagon into
blood
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Type I Diabetes No insulin production Takes insulin injections Usually young children or adolescents
affected (juvenile diabetes) Quick onset, progresses rapidly unless
treated.
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Type I Diabetes - Warning Signs
Frequent urination and unusual thirst Extreme hunger Rapid weight loss Tire easily, weak and fatigued Irritability Nausea
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Type I Diabetes - Treatment
Daily insulin injection– Syringe– Insulin pump
Insulin controls; no cures
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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
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Type II Diabetes – Warning Signs
Blurred vision Numbness in legs and arms Slow healing of cuts and bruises Sleepy
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Type II Diabetes - Treatment
Diet Oral medications:
• Diabeta, Diabinese, Dymelor, Glucotrol, Micronase, Orinase, Tolinase, Glucophage, Glyburide
Insulin injections as disease progresses
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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
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Testing Blood SugarPrepare blood glucose meter and Prepare blood glucose meter and test strip.test strip.
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Cleanse skin with alcohol prep.Cleanse skin with alcohol prep.
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Use lancet to perform finger stick.Use lancet to perform finger stick.
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Apply the blood to test strip.Apply the blood to test strip.
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Read blood glucose test results.Read blood glucose test results.
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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.
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Causes of Inaccurate Reading
Meter not calibrated Low batteries in meter Improperly stored or expired test
strip Insufficient blood on test strip
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Problems in Diabetes
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Blood Sugar Imbalance
Hyperglycemia (diabetic coma)– Diabetic ketoacidosis (DKA)
Hypoglycemia (insulin shock)
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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
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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
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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
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Hyperglycemia
Management– Support ABC’s – Treat for hypovolemic shock– Transport– When in doubt, give sugar!
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Hypoglycemia
Causes– Insulin overdose– Normal insulin use without eating– Over-exercise
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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”
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Hypoglycemia
Insulin shock isn’t really shock Patient just looks “shocky” because of
epinephrine adrenals are releasing
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Hypoglycemia
Can occur in non-diabetics Most common cause =
ETOH on empty stomach A patient is never “just drunk”
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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
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Hypoglycemia Management
Unconscious patient– Support ABC’s– Get ALS back-up for IV glucose
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Ask All Diabetics
Have you eaten today? Have you taken your medication today? When in doubt, give Sugar!
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Altered Mental Status
Causes of Altered MentalStatus– Hypoglycemia– Poisoning (including alcohol & drugs) – Infection– Head trauma– Hypoxia
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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.
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