1. Chapter 18 Diabetic Emergencies Slide Presentation prepared by Randall Benner, M.Ed., NREMT-P © 2012 Pearson Education, Inc.

2. Learning Objectives Understand the basic disease process associated with diabetes mellitus. Differentiate between hyperglycemia and hypoglycemia. List the signs and symptoms of hyperglycemia. List the signs and symptoms of hypoglycemia. Describe and demonstrate the first aid care of a severe hyperglycemic victim. Describe and demonstrate the first aid care of a hypoglycemic victim. © 2012 Pearson Education, Inc.

3. Introduction More than 14 million diabetics in the U.S. First indication of the disease often occurs when a patient experiences their first diabetic emergency First Aiders can provide better care when they understand the underlying disease process and management goals. © 2012 Pearson Education, Inc.

4. Diabetes Overview Role of insulin in glucose transport into cell –Glucose levels rise in the blood stream, causing additional complications. –Cells resort to using fat and proteins for glucose creation. –Without insulin, the glucose still cannot enter the cell. © 2012 Pearson Education, Inc.

5. Use of Sugar in Diabetes © 2012 Pearson Education, Inc.

6. Types of Diabetes Type I (IDDM) –Little or no insulin production –Usually starts in childhood Type II (NIDDM) –Insufficient secretion of insulin, or low sensitivity of cells to insulin presence –Formerly known as adult onset diabetes Gestational diabetes –Occurs as a result of pregnancy –Managed with diet, and occasionally, medications © 2012 Pearson Education, Inc.

7. Hyperglycemia Characteristics Hyperglycemia (high levels of glucose) –Glucose spills into urine, patient becomes dehydrated and acidic –Altered mental status, dehydration, poor vitals –Fever, hyperventilation, abdominal pain –Fruity odor on breath, air hunger –Frequent urination, intense thirst © 2012 Pearson Education, Inc.

8. Hyperglycemia Signs & Symptoms © 2012 Pearson Education, Inc.

9. Hypoglycemia Characteristics Hypoglycemia (low levels of glucose) –Low glucose levels result in brain dysfunction and changes in mental status –Possibly combative, dizzy –Rapid pulse and breathing, blood pressure usually normal –Seizures or tremors –No thirst, no excessive urination –Moist, pale skin, no fever © 2012 Pearson Education, Inc.

10. Hypoglycemia Signs & Symptoms © 2012 Pearson Education, Inc.

11. Other Assessment Considerations Always assess for history of diabetes in unresponsive patients. –Medical Alert Tag –Insulin injection marks on thigh or abdomen –Insulin pump on the body –Evidence of diabetic medicine near/on patient If in doubt, the careful administration of sugar to the patient will not be harmful. © 2012 Pearson Education, Inc.

12. Hyperglycemia vs. Hypoglycemia © 2012 Pearson Education, Inc.

13. First Aid: Hyperglycemic Victim Take standard precautions, activate EMS. Consider manual stabilization of cervical spine. Open and maintain the airway. Provide artificial ventilations if breathing is inadequate. Be alert for vomiting, position patient on their side if no trauma is suspected. Treat for shock, keep the patient warm. Reassess and reassure the victim until EMS arrives. © 2012 Pearson Education, Inc.

14. First Aid: Responsive Hypoglycemic Victim Take standard precautions, activate EMS. If patient can follow commands –Administer orange juice with added sugar. –Administer concentrated oral glucose if available. Do NOT give hard candy. Watch for vomiting, position patient on side. Treat for shock, keep the patient warm. Reassure and monitor the victim until EMS arrives. © 2012 Pearson Education, Inc.

15. First Aid: Unresponsive Hypoglycemic Victim Take standard precautions, activate EMS. Consider manual stabilization of cervical spine. Open and maintain the airway. Provide artificial ventilations, if necessary. Watch for vomiting. Position patient on their side if no trauma is suspected. Treat for shock, keep the patient warm. Monitor continuously until EMS arrives. © 2012 Pearson Education, Inc.

16. Summary Diabetes is a common disease in the U.S. population. The disease occurs when the body produces too little insulin or cannot effectively use the insulin it produces. Hyper- and Hypo- glycemia are the two conditions that arise from diabetic complications. Untreated diabetes, hyperglycemia, and hypoglycemia are serious conditions requiring medical intervention. © 2012 Pearson Education, Inc.