EMT-Chapter 20-Acute Diabetic Emergencies

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EMT-Chapter 20-Acute Diabetic Emergencies
2013-07-08 16:29:26
EMT diabetes endocrine

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  1. Diabetes Mellitus (DM)
    • A disease of altered relationships between glucose and insulin.
    • Either a lack of insulin being secreted by the pancreas or the inability of the cell receptors to recognize the insulin and allow glucose to enter at a normal rate.
    • Patients usually complain of thirst (polydipsea), frequent urination (poly uria), and is typucally hungry(polyphagia).
  2. Glucose
    • A form a sugar that's the body's basic source of energy.
    • Since glucose draws H2O with it, giving glucose to a stroke or head injury patient will lead to swelling of the brain cells,  increase edema and worsen the situation.
  3. Insulin
    • A hormone that promotes the movement of glucose from the blood into the cells.
    • Increases the movement of glucose out of the blood and into the cells.
    • Causes the liver to take up glucose out of the blood and convert into glycogen for storage.
    • Decreases blood glucose level (BGL)
  4. Glucagon
    • A hormone that stimulates the liver to convert stored glycogen and other substances into glucose.
    • Converts glycogen stored in the liver back into glucose and releases it into the blood.
    • Converts other non carbohydrate substances into glucose.
    • Increases BGL.
  5. Epinephrine (Adrenaline)
    Stops secretion of insulin and promotes the release of stored glucose
  6. Normal Metabolism and Glucose Regulation
    • Normal range 70-120mg/dL
    • 120-140mg/dL after a meal
    • Glycogen in the liver can last up to 24-48hrs
  7. Hypoglycemia
    • Low blood glucose.
    • A blood glucose level of 60mg/dL with signs or symptoms of hypoglycemia or of less than 50mg/dL with or without signs or symptoms of hypoglycemia.
  8. Hyperglycemia
    • High blood glucose.
    • A persistant blood glucose level greater than 120mg/dL.
  9. Testing BGL with a Glucose Meter
    • Glucose meter
    • Glucose meter test stripes
    • Lancet
    • Alcohol swabs
    • 1. Prepare the lancet and lancet device
    • 2. Let the arm hang down at the patient's side if possible
    • 3. Remove a new test strip from the vial. Insert the test strip.
    • 4. Match the code number
    • 5. When the blood drop symbol flashes on the LED screen
    • 6. Grasp the finger near the site to be pricked (make sure the alcohol dries completely)
    • 7. Keeping the hand downward, prick the side of the fingertip, squeeze the first drop out and use the second drop for testing
    • 8. Drop the blood onto the specific area of the test strip
    • 9. The value will be displayed
    • 10. Remove the strip into a biohazard container
  10. Type 1 Diabetes
    • Condition in which the pancreas typically does not secrete any insulin; insulin-dependent diabetes mellitus (IDDM)
    • Typically develops during a younger age
    • Less common than type 2
    • Due to lack of insulin secretion, type 1 is more prone to diabetic ketoacidosis(DK)
    • May suffer from hypoglycemia
  11. Type 2 Diabetes
    • Diabetes that can be regulated by diet, exercise, and drugs other than insulin; non-insulin-dependent mellitus(NIDDM)
    • Usually middle-aged or older
    • Prone to hyperglycemic hyperosmoler nonketotic syndrome(HHNS)
  12. Hypoglycemia
    • Epinephrine is released, therefore patients with hypoglycemia may have tachycardia, diaphoresis, and pale cool skin 
    • Weakness
    • Hunger
    • Dizziness
    • Warm sensation
    • Confusion
    • Disorientation
    • Seizures
    • Stroke like symptoms
    • Always ensure open airway
    • Nonrebreather mask 15lpm if cannot administer oral glucose
    • PPV if inadequate breathing
    • Contact ALS
    • If the patient is responsive, able to swallow, and able to obey commands, administer oral glucose
  13. Oral Glucose
    • A form a sugar often given as a gel, by mouth, to raise the BGL
    • Only can be administered if:
    • 1. patient has altered mental status
    • 2. has a history of diabetes controlled by medication or a BGL reading less than 60mg/dL
    • 3. has the ability to swallow
  14. Diabetic Ketoacidosis (DKA)
    • BGL usually above 350mg/dL
    • 3Ps
    • Tachycardia
    • Nausea/vomiting
    • Fruity or acetone odor on the breath
    • Poor skin turgor
    • Rapid deep respiration
    • Muscle cramps
    • Abdominal pain
    • Warm, dry, flushed skin
    • Altered mental statutus
    • 1. Maintain airway
    • 2. PPV if needed and O2
    • 3. Administer glucose if able to
  15. Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
    • BGL usually 600-1200mg/dL
    • Tachycardia
    • Fever
    • Dehydration
    • Dizziness
    • Poor skin turgor
    • Weakness
    • Altered mental status 
    • Confusion
    • Dry oral mucosa
    • Dry, warm skin
    • 1. Maintain airway
    • 2. PPV and O2 if needed
    • 3. Administer glucose if possible
  16. Medications Usually taken by Diabetics
    • Insulin(humilin, novolin, iletin, semilente)
    • Actos
    • Diabenese, Glucamide
    • Orinase
    • Micronase, DiaBeta
    • Tolinase
    • Glucotrol
    • Glynase
    • Exenatide(Byetta)
    • Lantus
    • Exubera