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
B lood S ugar F alls
B rain lack s ad eq uate glucose A d renal G land s release E p inep hrine
A lterations in consciousness; S eizures; H ead ache; U nusual B ehavior
P ale; C ool sk in; S w eating; T achycard ia; Increased B P ; N ausea
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