November 20, 2019

Diabetic Emergencies


[laughing] Speaker 2: Elizabeth, are you feeling
okay? Speaker 3: I don’t know. I don’t feel very good. Speaker 2: I think we should go
find some help. Speaker 1: Now let’s take a closer look at diabetic emergencies. When
we talk about diabetic emergencies, we could get really, really intricate about what causes
it and is it insulin resistance and all that kind of stuff, but I think for the sake of
this training, we’re going to simplify it down to two major types of emergencies that
can occur due to a diabetic emergency and that is this: high blood sugar and low blood
sugar. Now, let’s break those out a little bit. High blood sugar and low blood sugar,
though they have the similar signs and symptoms, high blood sugar is different for a couple
different reasons. High blood sugar can develop in hours to days, and when it develops, it’s
a little bit different in that it also shows some symptoms like a child needing to drink
more often than normal. Maybe they’re drinking more water, maybe they’re drinking more pop,
maybe they’re just always thirsty. We call this polydipsia. Polydipsia is that insatiable
thirst that they cannot quench. Now, when they have this symptom, it’s usually accompanied
with having to go to the bathroom a lot as well. That’s another way that the body’s trying
to get rid of that excess sugar in their bloodstream and in their tissues and that’s by going to
the bathroom a lot. So another sign or symptom. Now, backing up just a little bit, let’s say
that you didn’t know that the child was a diabetic. These are sometimes the first signs
of juvenile diabetes is that we see the child drinking more than they usually do and going
to the bathroom more than they usually do. Not that that’s always for sure, but it’s
definitely a flag that should maybe bring us to the doctor and take a closer look. And
now back on track with the high blood pressure. One of the last symptoms that’s really bad
and is usually at the tail end of a high blood sugar event is something we call ketoacidosis.
Now ketones can be actually smelled on the breath of a high blood sugar patient. It’s
usually like cheap wine or a fruity overtone, and that can be an indicator that the person
is suffering from high blood sugar. So what can we really do about high blood sugar out
in the field? Not a whole lot. We can activate emergency medical services or get the person
to an emergency room so that they can be definitively treated and get back on track. Now let’s focus
more on the one that you can do something about in the field, and that’s low blood sugar.
So, in a low blood sugar event, it’s different from high blood sugar in that it can come
on within seconds to minutes and it can surprise people. Whether they’re a known diabetic or
an unknown diabetic, the treatment should be about the same. So what is the goal of
getting someone into a more stable position when they have a low blood sugar event and
are showing those signs and symptoms of dizziness, lethargy, they might be confused, they might
have slurred speech, they don’t want to play anymore, they’re grumpy? Getting them sugar.
But there’s different ways to get the sugar into their system faster than others, and
I want to talk about that here in just a minute. There’s lots of different food sources around
that we can choose from but not all of them will get the sugar into the bloodstream as
quickly as the ones I’m going to talk about next. If you look at some of these high-grain,
high-fiber snacks that are common at a picnic table, they’re good and in some cases they’re
good for you, but they’re not necessarily good to treat a diabetic emergency. Meat sticks,
granola bars, and chips are probably not our first choice to getting their blood sugar
up. Though they can over a longer period of time, that’s not our emergency treatment.
I want to take a look at some that are a little bit faster and are more preferable under the
treatment guidelines. Orange juice is a fantastic way to get their sugar up. In this one small
bottle, there’s literally 44 grams of sugar. They shouldn’t have to drink much more than
a third to a half the full container to give them more than enough sugar to get their blood
sugar level back to where it should be, get them thinking more clearly, and then buy us
some time for EMS to arrive or to get them to their doctor or to an emergency room. A
couple other options that you could use are over-the-counter, you could get them at most
drug stores, probably some grocery stores, and that’s glucose in the form of tablets,
in the form of liquid, and in the form of a gel. The reason I like these is that they’re
closed, sealed bottles, and they’re really stored in a more stable state. You got orange
juice here, but in most cases it needs to stay refrigerated, and it has an expiration
date that probably is a little faster than some of these other options. Now, I like these
because, depending on the child, they may have something that they like more than the
other. Maybe they like chewing candy so you would opt for the tabs, but keep in mind that
you should know, and here’s a little Roy hint, you might want to write on this the number
that you should be using, your doctor would probably tell you this, because in this case,
every tablet’s only 4 grams of sugar. So you might think it’s one tablet per treatment,
but in actuality, to equal the half of this bottle, you need five tablets. It’s four grams
per tablet, you would like five to equal the half bottle of orange juice. The liquid here
comes in 22 grams by itself, and the gel is another 18 grams. So understanding how much
sugar or glucose is actually in these tabs is important. Remember that these have been
designed to absorb quickly into the digestive tract of the patient, and so they may work
a little faster than a candy or a regular soda. Now, one point of interest here where
we come to drinking over-the-counter beverages is be careful of diet things. Diet sodas tend
not to have any sweetener that’s sugar-based or glucose-based at all. So we’ve actually,
I’ve had patients who they’ve gotten treated with diet pop and their family didn’t understand
why it didn’t bring their loved one around. Well, it was because there wasn’t any sugar
in the soda. So make note of that, no diet sodas, no diet candies, they won’t work in
this situation. The second point is that it can take up to fifteen minutes to actually
absorb the amount of sugar or glucose needed to reverse the effects of a hypoglycemic event.
So remember, if this person is a known diabetic and a doctor is giving you a prescription
of what to do if they have a low blood sugar event, it may be that after you give them
the appropriate amount of sugar or glucose, that you wait five, ten, fifteen minutes to
see if it reverses the hypoglycemic symptoms before you activate emergency medical services.
However, if this is your first hypoglycemic event, it’s going to be important to call
9-1-1 right away. The other piece here to note, in closing, is that when we have these
different packages, they almost all come with a seal. As I was preparing these for this
instructional, I was picking at the actual seal, and I realized that some of them are
very difficult to undo. Now, keep in mind, some of the effects of the decreased level
of consciousness and confusion is only going to make opening these that much more difficult.
So if you can take the outer seal off, it’s just a protective device so that you know
it has never been opened, get it prepared so that you can open it more easily and consume
its contents when it’s an emergency and it counts. So, I hope this helps, wait for EMS,
watch the patient to develop any life-threatening problems, and if they do, we’ll know what
to do, we can move on to our next level of treatment.

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