 Frequently causes changes in patient’s mental status because of fluctuating blood sugars  More than 10 million Americans  5.4 have been undiagnosed

 3 major food sources › Carbohydrates, fats & proteins  3 major sources of carbohydrates (Complex Sugars) › Sucrose, Lactose, Starches  Simple Sugars › Glucose, Galactose, Fructose

Sources Roles Brain cells

 Most important sugar  Major source of fuel for cells  Brain cells cannot use anything but  If blood glucose stays low brain cells will die

 Hormone made in pancreas  Secreted when glucose is high  Functions › Increases movement of glucose out of bloodstream into cells › Causes liver to take up glucose & convert it to glycogen › Decreases blood glucose level by moving into the liver & cells

 Also made in pancreas  Secreted when glucose low  Functions › Converts glycogen stored in the liver back to glucose & releases into bloodstream › Converts other noncarbohydrate substances into glucose › increases & maintains glucose levels

 Epinephrine › Released by the adrenal glands › Stops the secretion of insulin › Promotes release of stored glucose from the liver › Promotes conversion of other substances into glucose

 Normal is mg/dl  Glycogen can be used for hours › If all used then body uses fats & proteins

 Disturbance in metabolism of carbs, fats, & proteins. › Lack of insulin being secreted › Inability of cell receptors to recognize insulin

 Type 1 › Insulin Dependent(IDDM) › Diabetic ketoacidosis (DKA)  Type 2 › Noninsulin dependent (NIDDM) › Hyperglycemic hyperosmolar nonketotic syndrome  Gestational › Pregnancy  Prediabetes

 High blood glucose- normal mg/dl  3 P’s › Polydipsia-excessively thirsty › Polyuria-excessive urination › Polyphagia-excessive hungry › 185 mg/dl  Kidneys can’t reabsorb high glucose & will spill it into the urine › 225 mg/dl › Significant amount of sugar in urine

 Low blood sugar  More common in Type 1  Pathophysiology › BG <50 › Altered mental status › Causes:  Increases level of activity drastically  Taking insulin/medication & not eat  Takes to much insulin

Epinephrine release Brain Cell Dysfunction  Diaphoresis  Tremors  Weakness  Hunger  Tachycardia  Dizziness  Pale, cool, clammy skin  Warm sensation  Altered mental status  Drowsiness  Disorientation  Unresponsive  Seizures  Strokelike symptoms including hemiparesis

 Airway  Oxygen  ALS  Oral Glucose

 Pure sugar  Only can be administered if patient is conscious & can swallow  Has history of DM controlled with medication  Has altered mental status

 High sugar level  Usually > 350 mg/dl  High sugar content in urine  Pull water out with urine

 Infection  Inadequate dose on insulin  Taking steriods, dilantin, & thiazide

 3 P’s  Nausea & vomiting  Poor skin turgor  Tachycardia  Kussmaul respirations  Fruity or acetone odor to breath  Muscle cramps  Abdominal pain  Warm,dry flushed skin  Altered mental status  coma

 Airway  Determine if patient able to swallow  Contact medical control as needed  Transport posisition of comfort

 Blood sugar significantly higher  Signs & symptoms › Tachycardia › Fever › Dehydration › Thirst › Dizziness › Poor skin turgor › Altered mental status › Confusion › Weakness › Dry oral mucosa › Dry, warm skin › Polyuria › Nausea & vomiting

 Airway  Oxygen  Transport position of comfort

 Scene size up  History & secondary assessment  Reassessement