AMS PART 1

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Temple College EMS Professions

Diabetes

Diabetes Mellitus

Metabolic disease

Characterized by inadequate,absent insulin production

Diabetes Mellitus

Key Term

The condition brought about by

decreased insulin product ion, or the

inability of the body cells to use

insulin properly (which prevents the

bodys cells from taking the simple

sugar called glucose from the

bloodstream)

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Glucose

Required as fuel for cellular metabolism

Brains need for glucose parallels itsdemand for oxygen

Insulin

Hormone

Produced by Islets of Langerhans inpancreas

Required for sugar to enter most cells

Brain does not require insulin to usesugar

Insulin allows sugar to pass from the

bloodstream into the cells.

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Pancreas

Located in

retroperitoneal space

Produces, releases

Digestive enzymesinto duodenum

Insulin, glucagon intoblood

Islets of Langerhans

Alpha cells

Glucagon

Raises blood sugar

Beta cells

Insulin

Lowers blood sugar

Type I Diabetes

No insulin production

Takes insulin injections

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Diabetes is treated with injections of

insulin or oral medications.

Type II Diabetes

Inadequate insulin production

Increased tissue resistance to insulin effects

Controlled with

Diet

Oral medications:

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

Insulin injections as disease progresses

Problems in Diabetes

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Blood Sugar Imbalance Hyperglycemia

Diabetic ketoacidosis (DKA) Hyperosmolar coma

Hypoglycemia

Hyperglycemia

Key Term

Hyperglycemia (high blood sugar) is

a slow-onset condition from

decreased insulin levels in people

with diabetes.

Hyperglycemia

Causes

Failure to take insulin

Overeating, eating wrong diet

Stress (fever, infection, emotional stress)

New-onset diabetics usually presentwith 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


Cells cannot burn sugar; patient experienceshunger (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-polishremover or fruity breath odor


Volume depletion

Ketone body production (ketoacidosis)

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Signs & Symptoms of

Hyperglycemia

Slow onset

Nausea/vomiting

Acetone odor on breath

Increased urination/hunger/

thirst

Hyperosmolar Coma

Usually Type II diabetic (inadequate 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

Hyperosmolar Coma

Cells continue to burn sugar

Acidic ketone bodies notproduced

Nail-polish remover or fruity breath odor not

present

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Hyperosmolar Coma

Severe volume depletion

NO ketone body production

Hyperglycemia

Management

Support ABCs

Treat for hypovolemic shock

Transport

When in doubt, give sugar!

Hypoglycemia

Key Term

Hypoglycemia (low blood sugar) is alife-threatening emergency for

people with diabetes.

It is the most common emergency

for the diabetic patient.

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Hypoglycemia

Causes

Insulin overdose Normal insulin use without eating

Over-exercise

Causes of Hypoglycemia

Af ter taking too much insulin

Vomiting

Af ter unusual amount o f exercise

Reduced sugar intake by not

eating

Hypoglycemia

Alterations in consciousness;Seizures; Headache;Unusual Behavior

Brain lacks adequate glucose

Pale; Cool skin;Sweating; Tachycardia;Increased BP; Nausea

Adrenal Glands release Epinephrine

Blood Sugar Falls

Pale, cool skin; sweating; nausea; tachycardia

Is that why hypoglycemia sometimes is calledInsulin Shock?

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Hypoglycemia

Insulin shock isnt really shock

Patient just looks shocky because ofepinephrine adrenals are releasing

Hypoglycemia

Can occur in non-diabetics

Most common cause :EtOH on an empty stomach

A patient is never, just drunk

Signs & Symptoms of

Hypoglycemia

Rapid onset

Intoxicated appearance, staggering,slurred speech, unconsciousness

Cold, clammy skin

Rapid heart rate

Seizures (severe cases)

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Unusual or bizarre behavior

Anxiety

Refusal to cooperate or

combativeness

Signs & Symptoms of

Hypoglycemia

Assess ing Diabetic

Emergencies

Perform initial assessment.

Perform focused history and

physical exam.

Get SAMPLE history.

Note any medical alert tags.

Take baseline vital signs.

Hypoglycemia Management

Conscious patient

Give sugar orally

Unconscious patient

Support ABCs

Get ALS back-up for IV glucose

When in doubt, Give Sugar!

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When & how did it start?

How long did it last?

Complaints of other symptoms?

Any trauma invol ved?

Continued

Assessing & Treating

Diabetic Emergencies


physical exam.

Any medical alert tags ?

Has the patient seized?

Fever?

Interruptions in episode?

Continued

Assess ing & Treat ing



physical exam.



Perform initial assessment.

Maintain airway.

Administer

oxygen.

Continued

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Get a SAMPLE history.

If the patient has a history of

diabetes:

When did patient last eat?

Any medications ? Las t taken?

Any other il lnesses?

Can the patient swallow?

Continued

Assess ing & Treating


Take baseline vital signs.

In some areas, protocols direct the

EMTB to tr eat the patient before

getting vital signs.

FOLLOW YOUR

LOCAL PROTOCOL!

Continued



History of diabetes

Altered ment al status

Patient can swallow

Continued



Give oral glucose if all of these

conditions are met:

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Reassess patient.

If patient becomes unconscious,

stop glucose administration

immediately and secure the airway!

If no improvement, consult medical

direction.

Continued



If patient is not awake enough to

swallow:

Secure airway.

Adminis ter oxygen.

Position appropriately.

Request ALS & transpor t.

Continued



Obtain a blood glucose reading, if

allowed by local protocols. Continued



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Blood Glucose Readings

80-120 mg/dl Normal

60-80 mg/dl Moderate hypoglycemia

Below 50 mg/d l Severe hypog lycemia

Above 140 mg/dl Hyperglycemia

Question results that are inconsistent

with patients condition.

Causes of Inaccurate Reading

Meter not calibrated

Low batteries in meter

Improperly stored or expired

test strip

Insufficient blood on test strip

Ask All Diabetics

Have you eaten today?

Have you taken your medication today?

When in doubt, give Sugar!

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Administration ofOral Glucose

Squeeze glucose onto tongue depressor

and place between cheek and gums.

If the patient is alert enough, let her

squeeze oral glucose into her mouth .

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When the glucose is gone, remove

tongue depressor and reassess patient.

If the patient loses consciousness, remove

tongue depressor, secure airway, and

transport promptly.

Oral Glucose

Altered mental status

with histor y of diabetes

Indications

Contraindications

Unconsciousness

Diabetic who has not

taken insulin for days

Inability to swallow

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Oral Glucose

Dosage One tube

Oral Glucose

Administrat ion

Assure altered mental

status with history of

diabetes.

Assure pat ient is

conscious.

Oral Glucose

Administrat ion

Admin is ter glucose on

tongue depressorbetween cheek and gum

or let patient self-

administer.

Perform ongoing

assessment.

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Oral Glucose

None when given properly

May be aspirated if given

to patient without gag

reflex

Side Effects

Actions Increases blood sugar

Oral Glucose

Reassessment Strategies

If patient seizes or loses

consciousness, remove

tongue depressor and

secure airway.

Other Diabetes Complications

Atherosclerosis

Myocardial infarction

CVA Peripheral vascular disease

Blindness

Renal failure

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Other Diabetes Complications

Diabetic Neuropathy

Gangrene Increased silent myocardial infarction risk

Silent MI

Acute MI in diabetic can present withoutchest pain

May resemble flu

Manage sick diabetics as if critically illuntil proven otherwise

AMS PART 1

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