1. Diabetic Emergencies Jennifer Burgess, Registered Nurse Nurse-Led Outreach Team

2. Objectives  What is diabetes?  What is hypoglycemia?  What is hyperglycemia?  What do I do in a diabetic emergency? How do we avoid one?  Where can I go for help?

3. What is diabetes?  Type 1: IDDM (Not preventable) the pancreas does not produce insulin glucose builds up in your blood instead of being used for energy.  Type 2: NIDDM (Preventable) Your body either: Cannot produce enough insulin OR Does not use the insulin it makes properly

4. What causes type 2 diabetes?  Age 40 or greater  Being overweight  Having a family member who has diabetes  Having had diabetes during pregnancy

5. Recommended Blood Sugar Targets  Normal Range A1C: ≤6.0% 4.0-6.0 mmol/L fasting (before meals) 5.0-8.0 mmol/L two hours after eating  Most People with Diabetes AIC: ≤7.0% 4.0-7.0 mmol/L fasting (before meals) 5.0-10.0 mmol/L two hours after eating *Some residents will feel most comfortable at higher ranges than this. Glucose control goals need to be discussed with the Primary Care Practitioner*

6. What is Insulin?  A hormone produced by your body Resident’s body may not have enough If they need to take insulin they will find that it makes them feel better and gives them the energy they need. Encourage them: Don’t be afraid of the injections. Most diabetics say it is much easier than expected.

7. What are Carbs?  One of our main sources of calories. Sugars naturally found in honey, fruits, veggies and milk Refined sugars such as table sugar or sugars added to candies, jams and soft drinks Starches such as grains, rice, potatoes, corn and legumes All forms of carbohydrate are broken down into glucose during digestion.

9. 15 g Carbohydrates  7 soda crackers  1 slice bread  2 digestive cookies  4 social tea biscuits  ¾ cup or 1 individual box of cereal Given with a source of protein

10. Proteins  Peanut butter (15mL)  Cheese (1oz)  1 Egg  250mL milk

11. Free fluids  Fluids that do not contain carbohydrate and therefore do not increase the blood sugar. (e.g. water, diet pop)

12. Avoiding Emergencies: Low Blood Glucose (Sugar)  Caused by: More physical activity than usual Not eating on time *snacks are important!* Eating less than you should have Taking too much medication The effects of drinking alcohol This can happen quickly.

13. Hypo (low) Glycemia (sugar)  They may feel: Shaky, light-headed Confused Hungry Increased heart rate Sweaty, headache Weak Numbness or tingling in their tongue or lips Not all residents will have these symptoms.

14. What do I do for low blood sugar?  Are they conscious?  Can they swallow?  Check ABC’s and follow CPR directives for that person.  Follow the appropriate clinical algorithm

15. Hyper (high) Glycemia (sugar)  Caused by: Food, activity and medications are not balanced. May happen when they are sick or under stress CBG value of >20 mmol/L. FOOD MEDICATIONSACTIVITIES

16. Early signs of hyperglycemia Increased thirst Headaches Difficulty concentrating Blurred vision Frequent urination Fatigue (weak, tired feeling) Weight loss

17. Plan  Confirm CBG >20 mmol/L  Notify practitioner to obtain stat PRN CBG orders and further direction  Corrective insulin dose  IV NaCl  Administer insulin according to practitioner’s orders  If resident is able to swallow safely and has clear or full fluids as part of their diet, encourage free fluid intake  Ongoing assessment: BP, pulse, resp, O2 sat  Follow up with practitioner and monitor resident until hyperglycemia is resolved.

18. Diabetic Ketoacidosis (DKA)  Acute and severe complication  Result of high levels of blood glucose and ketones  Associated with poor control of diabetes or as a complication of other illnesses.  Can be life threatening, requires emergency treatment

19. Signs of DKA  Fruity odour on the breath  Shortness of breath  Confusion  Nausea and/or vomiting  Weight loss Transfer to hospital.

20. Hyperglycemia  Includes assessment of: Glycemic control (how have sugars been over time?), include A1C Meals and snacks Medications Monitoring Physical activity Routine follow up Educational needs

21. When a resident is sick  Test blood glucose every 2-4 hours – obtain a physician’s order to do so.  Continue to administer diabetes medication  Many cold remedies and cough syrups contain sugar – try to pick sugar free products. The pharmacist can help you make a good choice.

22. When a resident are sick  Encourage plenty of extra sugar-free fluids or water  Replace solid food with fluids that have sugar if they can’t eat as usual They should try to consume 10g of carbohydrate every hour  Call the practitioner if they vomit more than twice in 12 hours  Continue to give their insulin, if the take insulin. They might need to be given more than usual depending on their blood sugar levels.

23. Teaching points for seniors  Be prepared  Report your diabetes to the motor vehicle licensing office Be aware of the changes to your insurance  Your province or territory may subsidize the cost of blood glucose monitoring supplies.

24. Support  Doctor  Nurse Practitioner  Nurse  Pharmacist  Dietitian  Social Worker  Psychologist  Foot care specialist  Endocrinologist  Opthamologist  The Canadian Diabetes Association: 1-800-BANTING (1-800-226-8464) www.diabetes.ca info@diabetes.ca

25. Questions?