Humongous Insurance

Diabetes
Diabetes (Terms)

Diabetes mellitus – (DM) A chronic

disease characterized by an altered
relationship between sugar (glucose) and
insulin.
 Diabetes

Insulin – A hormone secreted by the

pancreas that is needed to promote the
movement of glucose (sugar) from the
blood into the cells.
Glucose – A simple form of sugar, the

body’s main source of energy.


 Diabetes

Type I (IDDM)- Insulin dependent



diabetes mellitus, usually acquired in

childhood, produce no insulin
(inheritable, auto-immune)
 Requires insulin administration
 Diabetes

Type II (NIDDM) – Non-insulin dependent



diabetes mellitus, usually acquired in

adulthood (related to overweight),
produce some insulin – not enough, or
tissue sensitivity diminished
 Can be controlled by diet, exercise, oral meds
Role of the Pancreas

Primary role is the



regulation of blood
glucose
concentrations.
 Diabetes
Role of the Pancreas
Islets of Langerhans produce insulin


 Alpha cells – Glucagon

 Beta cells – Insulin

 Delta cells – Somatostatin (inhibits the

secretaries of growth hormone)

Islets of Langerhans
 Diabetes
Beta Cells
Insulin


 Increase glucose transport into the cell

 Increase liver glycogen levels (storage)
 Decrease blood glucose concentration
 Glucagon Antagonist
 Diabetes
Alpha Cells
Glucagon –


 Released when blood sugar levels drop

 Increase blood glucose levels
 Breaks down fats and fatty acids (storage removal)
 Insulin Antagonist
High/Low Blood Sugar
 Diabetes
Glucagon
Triggered by exercise, stress, sleep,
hypoglycemia
Insulin antagonist (decreases insulin’s

actions)
 Diabetes
Long Term Effects
Blindness
Kidney disease

Peripheral neuropathy

Heart disease and stroke

 (atherosclerosis)
 HD: 2X - 4X non-diabetic
 S: 2X - 6X non-diabetic
Limb amputations

 Diabetes
Hyperglycemia – Lack of insulin, glucose cannot
enter the cells. Remains in the blood stream
increases the level of blood sugar.


Hypoglycemia (Insulin Shock) – Lack of glucose

in the blood stream, cells deprived of glucose.


Normal sugar level – 80-120 mg/dL


 Diabetes
Onset
Type I – May occur at birth, usually occurs in


teenage or young adult years

 Typically a sudden onset of
 Polyuria (excessive urination),
 Polydipsia (excessive thirst),
 Polyphagia (excessive ingestion of food), dizziness,
blurred vision, rapid and unexplained weight loss.
 Diabetes
Onset
Type II –


 Generally occurs in patients older than 40 y/o

 Overweight patients
 Same onset S/S as Type I and fatigue, changes in
appetite.

Get Off Me
Woman!!!
 Diabetes
Hypoglycemia (Insulin Shock)
 Hypo (Low), Glyce (Sugar), Emia
(Blood)
 Excessive response to glucose
absorption
– Physical exertion
– Alcohol
– Drug effects
– Pregnancy
– Poor dietary intake
 Diabetes
Hypoglycemia (Insulin Shock)

Adult


 Blood sugar less than 80 mg/dL (non-diabetic)

 Blood sugar less than 110 mg/dL (diabetic)
Pediatric


 Blood sugar less than 60 mg/dL (non-diabetic)

 Blood sugar less than 90 mg/dL (diabetic)
 Diabetes
Hypoglycemia (Insulin Shock)

Too much insulin

Decreased dietary intake (missed

meal)
Vigorous activity


 Diabetes
Hypoglycemia (Insulin Shock)
S/S

 Appearance of
 Rapid onset
intoxication
 Nervousness  Weak, rapid pulse
 Irritability
 Cold, clammy skin
 Combative behavior
 Drowsiness
 Weakness
 Seizures
 Confusion
 Coma (severe
case)

 Hyperglycemia
Hyper (High), Glyce (Sugar), Emia
(Blood)
Slow onset

Absence or lack of insulin

Glucose accumulates in the blood

Cells are starved

 Search for alternate fuel

 Excessive urination (dehydration)
 Hyperglycemia
Diabetic Ketoacidosis
Results in a low pH


(acidosis)
 Fruity breath
Vomiting, dehydration,
altered electrolyte
balance, seizures
Abnormal breathing

pattern.
 Kussmaul respirations
 Deep & fast
 Warm, dry skin
 Hyperosmolar
Hyperglycemic Nonketotic
 Life-threatening emergency
 Older patients with type 2 diabetes or
undiagnosed diabetics
 Causes
 Precipitating factors
 Signs and symptoms
Pathophysiology of HHNK
Coma
Diabetic Emergency
Management
Scene Size Up / BSI
Initial Assessment

 LOC
 ABC’s
 C/C
 Priority/Transport

Diabetic Emergency
Management
Focused History and Physical


Examination/Rapid Assessment
 Responsive - Focused
 Unresponsive – Rapid Medical Assessment
 OPQRST
 SAMPLE
 Diabetic Emergency
Management
 OPQRST  SAMPLE
– Onset – Signs & Symptoms
– Provocation – Allergies
– Radiating – Medications
– Quality – Past Medical Hx
– Severity – Last oral intake
– Time – Events Leading to 911
call
Diabetic Emergency
Management
 Common Meds identified in
SAMPLE:
– Insulin
– Diabanese – Glynase
– Orinase – Tolinase
– Micronase – Glucotrol
– Diabeta – Humalog
– Rezulin
– Glucophage
 Diabetic Emergency
Management
 Treatment
– High flow oxygenation
 (BVM vs. NRB)
– Suction
 Oral/nasal airway
Diabetic Emergency
Management
Can the Patient Swallow?


 If so, oral glucose PO

 If not, NPO, rapid transport
Oral glucose:


 Raises the blood sugar, may take as long as 20

min.
 Indications – Altered mental status, history of
diabetes, ability to swallow
 Page 475
Oral Glucose Drug
Sheet
 Oral Glucose
Class: Carbohydrates
Route: Oral

Supplied: Squeezable Tubes

Dose:

 Adult: Full Tube (25-50gm) given in small doses

 Pediatric: 0.5 gm/kg given in small doses



 Oral Glucose Cont.
Drug Action: Increases Blood Glucose Level
Indications:

 Altered mental status caused by hypoglycemia:

 Adult
 Blood sugar less than 80 mg/dL (non-diabetic)
 Blood sugar less than 110 mg/dL (diabetic)
 Pediatric
 Blood sugar less than 60 mg/dL (non-diabetic)
 Blood sugar less than 90 mg/dL (diabetic)
 Oral Glucose Cont.
Precautions:


 Assure gag reflex is present

Side Effects: Aspiration
Contraindications:

 Absent gag reflex

 Patents unable to protect their airway
 Patents unable to swallow.



 Diabetic Emergency
Management
Baseline Vital Signs (Q 5 or 15 min)
Detailed Patient Assessment

Ongoing Assessment

 ABC
 LOC
 Consider other causes
Scenarios
 Scenario 1

Dispatched to an unconscious person. 32

y/o female. She has a history of DM.
S/S – Sudden onset of altered LOC, did

not eat supper, cool moist skin, rapid

thready pulse, did take insulin.
What is the level?
 What is wrong with
her?
 Hypoglycemic
 Treatment
– High flow oxygenation
– Suction Oral/nasal airway if needed
– Oral glucose PO if able to swallow
– If not, rapid transport
 Scenario 2

Dispatched to a 46 y/o old male. Large

patient, family brings meds to you. They
include Diabeta.
Patient has not been feeling well for the

past day or so.

 Scenario 2

S/S: Rapid and deep respirations, skin



warm and dry, dry mucous membranes,

patient exhibiting bizarre behavior, pulse
rapid and thready, history of Polyuria,
Polydypsia, and Polyphagia.
 What is wrong with
him?
 Hyperglycemia or DKA
 Treatment:
– High flow oxygenation
– Anything else?
– Rapid transport
 Scenario 3

Dispatched to 80 y/o for altered mental

status. History of diabetes that is
normally controlled with insulin.
S/S: Nausea, vomiting, irritability, altered

mental status, weak, rapid pulse, and no

range of motion of the right side of body.
 What is wrong with
her?
 CVA or Stroke
 Treatment:
– High flow oxygenation
– Anything else?
– Rapid transport
 Other factors to consider

Intoxication
Other causes of AMS
 Glucometer
A device used to determine blood


glucose levels.

 Indications for blood
sugar analysis
Altered Mental Status
Unconscious patients of unknown cause

Suspected diabetic patients

 Procedure

Clean finger with

alcohol
Wipe dry

Wipe away first

drop of blood
Use second drop of

blood
 Abnormal Glucose
Values

Outside the normal range (60-120)



 Hyperglycemia – Greater than 300

 Hypoglycemia – Less than 60
 Conditions Diminishing
Accuracy
Margin of error (10- Insufficient sample
15%) size
Missing calibration
Contamination
Temperatures
Wrong sample
Outdated strips
source
Improper technique
Neonates
Review
 Review
IDDM


 Insulin Dependant Diabetic

 Type I

 Review
NIDDM


 Non-insulin Dependant Diabetic

 Type II
 Review

 3 P’s
 Polydipsia

 Ployphagia

 Polyuria
 Review
Hypoglycemia
Adult

 Blood sugar less than 80 mg/dL (non-diabetic)

 Blood sugar less than 110 mg/dL (diabetic)
Pediatric


 Blood sugar less than 60 mg/dL (non-diabetic)

 Blood sugar less than 90 mg/dL (diabetic)
 Review
Hyperglycemia


 >120 mg/dl
 Review
DKA


 Diabetic Ketoacidosis
 Kussmaul Respirations
 D-stick normally > 350 mg/dl
 The End

Questions?
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