Diabetes – What is it? Hormone (insulin) needed to regulate blood glucose levels is ineffective; Glucose levels can get too high or too low Type I - patients do not produce insulin at all, need daily injections typically strikes children, but also adults patients more likely to suffer organ damage - eg blindness, heart disease, kidney failure Type II – patients have inadequate or ineffective insulin usually controlled with diet, exercise, drugs

Diabetes – What is it?

Diabetes – Hypoglycemia Causes - too much insulin, - not enough food, - excessive exercise, - has been ill, - overdose of oral medication (special problem with kids) S&S: What do you see - develops quickly (perhaps minutes) - altered level of consciousness - hungry; NO thirst or nausea - Progression = fainting, shock, seizure, coma classic shock signs – form of Metabolic Shock pale/clammy skin, rapid pulse, rapid respirations Low blood sugar – all glucose taken out

Diabetes – Hyperglycemia High blood sugar – cells starved for glucose Causes - insufficient insulin - markedly overeats, - undergoing stress (infection, illness, overexertion, alcohol) S&S: What do you see - develops slowly (hours to days) - rapid & deep respirations (kassmaul) and sweet, fruity breath - dehydration (dry, warm skin & sunken eyes - very thirsty, excessive urination, nausea - restless merging to coma

Diabetes – What can you do? Most diabetics understand and manage their disease well. Care for the Diabetic –If unresponsive = monitor airway, administer high flow O2, call for emergency transport –If responsive Get medical history, look for medic alert tags USE THE 6 th ALWAYS QUESTION! Give glucose orally if can swallow, even if not sure hypoglycemic Feed a recovered hypoglycemic patient –If patient does not respond to glucose = Rapid Transport Diabetics can have a ‘silent” or painless heart attack

Diabetes – Administering Glucose Effects should be seen very quickly if hypoglycemic

Substance Abuse – What do you see? Signs and Symptoms vary with category of drug taken CNS Depressants – depress all autonomic functions General S&S: hypoventilation, hypotension, sedation or coma –Sedatives - eg valium, seconal (+ slurred speech) –Inhalants – eg glue, acetone (+ seizure) –Narcotics/Opiods – eg heroin, oxycodon, morphine, vicodin (+ constricted pupils) –Alcohol & Marijuana CNS Stimulants – either stimulate sympathetic or block parasympathetic General S&S: dilated pupils, hypertension, tachycardia, agitation or seizures, hypothermia –Class 1 – eg cocaine, amphetamines –Class 2 - eg atropine (+ dry skin & mucus membranes)  increases heart rate; can be administered variety of ways –Hallucinogens – eg LSD

Substance Abuse – What can you do? ABC -> Maintain airway, Administer O2, assist ventilations if necessary -> Watch for seizures, vomiting -> Preserve vomit, bottles, pills, etc and send with patient to hospital If unresponsive, –Place in recovery position, –Treat for shock, –Transport ASAP If responsive –Calm if agitated; do not try to restrain –Find out (i) what was taken, (ii) when taken, (iii) how much, (iv) any actions taken, and (v) how much weigh –Transport ASAP => Do Not Leave Alone <=