Diabetes
Temple College
EMS Professions
Glucose
Required as fuel for cellular metabolism
Brain’s need for glucose parallels its
demand for oxygen
Insulin
Hormone
Produced by Islets of Langerhans in
pancreas
Required for sugar to enter most cells
Brain does not require insulin to use
sugar
Pancreas
Located in
retroperitoneal space
Produces, releases
– Digestive enzymes
into duodenum
– Insulin, glucagon into
blood
Islets of Langerhans
Alpha cells
– Glucagon
– Raises blood sugar
Beta cells
– Insulin
– Lowers blood sugar
Diabetes Mellitus
Metabolic disease
Characterized by inadequate,
absent insulin production
Type I Diabetes
No insulin production
Takes insulin injections
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
Blood Sugar Imbalance
Hyperglycemia
– Diabetic ketoacidosis (DKA)
– Hyperosmolar coma
Hypoglycemia
Hyperglycemia
Causes
– Failure to take insulin
– Overeating, eating wrong diet
– Stress (fever, infection, emotional stress)
New-onset diabetics usually present
with an episode of hyperglycemia
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
Diabetic Ketoacidosis
Cells cannot burn sugar; patient experiences
hunger (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-polish
remover or “fruity” breath odor
Diabetic Ketoacidosis
Volume depletion
Ketone body production (ketoacidosis)
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 not produced
Nail-polish remover or “fruity” breath odor not
present
Hyperosmolar Coma
Severe volume depletion
NO ketone body production
Hyperglycemia
Management
– Support ABC’s
– Treat for hypovolemic shock
– Transport
– When in doubt, give sugar!
Hypoglycemia
Causes
– Insulin overdose
– Normal insulin use without eating
– Over-exercise
Hypoglycemia
Blood Sugar Falls
Brain lacks adequate glucose Adrenal Glands release Epinephrine
Alterations in consciousness; Pale; Cool skin;
Seizures; Headache; Sweating; Tachycardia;
Unusual Behavior Increased BP; Nausea
Pale, cool skin; sweating; nausea; tachycardia
Is that why hypoglycemia sometimes is called
“Insulin Shock?”
Hypoglycemia
Insulin shock isn’t really shock
Patient just looks “shocky” because of
epinephrine adrenals are releasing
Hypoglycemia
Can occur in non-diabetics
Most common cause =
EtOH on empty stomach
A patient is never, just drunk
Hypoglycemia Management
Conscious patient
– Give sugar orally
Unconscious patient
– Support ABC’s
– Get ALS back-up for IV glucose
When in doubt, Give Sugar!
Ask All Diabetics
Have you eaten today?
Have you taken your medication today?
When in doubt, give Sugar!
Other Diabetes Complications
Atherosclerosis
– Myocardial infarction
– CVA
– Peripheral vascular disease
– Blindness
– Renal failure
Other Diabetes Complications
Diabetic Neuropathy
– Gangrene
– Increased “silent” myocardial infarction risk
Silent MI
Acute MI in diabetic can present without
chest pain
May resemble “flu”
Manage “sick” diabetics as if critically ill
until proven otherwise