Copyright 2009 Seattle/King County EMS Overview of CBT 450 Diabetic Emergencies Complete course available at

Copyright 2009 Seattle/King County EMS

Overview of CBT 450 Diabetic Emergencies

Complete course available at www.emsonline.net


IntroductionDiabetic Emergencies • Diabetes affects 20.8 million people

• At least one-third of people with diabetes are unaware they have the disease


Practical Skills

• Patient assessment

• Blood glucometry

• Oral glucose

To receive CBT or OTEP credit, you must perform the following practical skills:


Termsacidosis — Excessive acid in the body fluids.

glucagon — A hormone produced by the pancreas that causes the liver to convert stored glycogen into glucose and release it into the bloodstream. The action of glucagon is opposite that of insulin.

hyperosmolar nonketotic coma — A complication of type 2 diabetes that results in extremely high glucose levels without the presence of ketones.

ketones — Acids that are the product of fat metabolism.


Terms, continued

polydipsia — Excessive thirst persisting for long periods of time despite reasonable fluid intake; often the result of excessive urination.

polyphagia — Excessive eating; in diabetes, the inability to use glucose properly can cause a sense of hunger.

polyuria — The passage of an unusually large volume of urine in a given period.


Glucose

Glucose, a form of sugar, is body’s main source of energy


Insulin

• A hormone produced by pancreas

• Helps glucose enter cells and produce energy


Types of Diabetes

Type 1 diabetes - body does not produce insulin so glucose cannot enter cells


Types of Diabetes, continued

Type 2 diabetes - body does not produce enough insulin or cells ignore insulin produced


Hypoglycemia

Too much insulin, too little food or too much exercise


Hypoglycemia, continued

Medical history• Insufficient food intake • Excessive insulin dosage • Normal to excessive activity • Rapid onset • Absent thirst • Intense hunger • Headache • Seizures • Recent illness, change in diet


Hyperglycemia

Too little insulin, not enough exercise or too much food


Hyperglycemia, continued

Medical history• Recent infection • Three Ps (polyphagia, polydipsisa,

polyurea) • Vomiting, abdominal pain • Flu-like symptoms, nausea • Insufficient insulin dosage • Gradual onset • Normal activity level


Hypo Vs. Hyper

• Insufficient food intake

• Pale, moist skin

• Rapid onset

• Weak, rapid pulse

• Low BP

• Low blood glucose

• Insufficient insulin

• Warm, dry skin

• Gradual onset

• Rapid, deep respirations

• Intense thirst

• Increased urination

• High blood glucose


Insulin Reaction

• Cold, pale, clammy skin • Abnormal, hostile, bizarre behavior (appears

intoxicated)

• Shaking, trembling, weakness • Full, rapid pulse • Normal or elevated blood pressure • Dizziness, headache, blurred vision • Extreme hunger • Seizures • Loss of consciousness


Diabetic Ketoacidosis

• High blood glucose levels

• The Three P’s

• Altered LOC (advanced DKA)


Diabetic Coma

Unconsciousness from severe hypoglycemia, diabetic ketoacidosis or hyperglycemia combined with profound dehydration


Patient History

• When did you eat last? • How much did you eat? • Have you taken your insulin today? • Has there been a change in your health, stress

or exercise level? • When did the symptoms begin?


Glucometry

1. Don gloves and eye protection.

2. Clean fingertip with an alcohol pad.

3. Grasp finger near area to be pricked and squeeze.

4. Prick side of finger with a sterile lancet and squeeze finger gently.

5. Place drop of blood on the test strip.

6. Read meter and record reading and time.


Care for Diabetic Emergency

• Request medic unit, if indicated

• Maintain airway

• Administer oxygen

• If able to swallow, give oral glucose

• Monitor vital signs and LOC


Oral Glucose

• Ask patient if able to swallow, if not don’t administer

• Position upright

• Ask patient to sip or chew sugar-containing substance

• Monitor patient’s response to glucose

• Repeat blood glucometry


Swallow Reflex

• Ability to swallow is an effective indicator of the ability to maintain an airway

If patient can’t swallow If patient can’t swallow don’t give oral glucosedon’t give oral glucose


Summary

Type 1 diabetes - body does not produce insulin

Type 2 diabetes - body does not produce enough insulin or cells ignore insulin produced


Summary, continued

Hypoglycemia - too much insulin, too little food intake or too much exercise

Hyperglycemia - too little insulin, not enough exercise or too much food


Summary, continued

Medical history suggesting hypoglycemia

• Insufficient food intake

• Excessive insulin dosage

• Normal to excessive activity

• Rapid onset

• Absent thirst

• Intense hunger

• Headache, seizures


Summary, continued

Medical history suggesting hyperglycemia

• Recent infection

• The Three P’s

• Vomiting, abdominal pain

• Flu-like symptoms, nausea

• Insufficient insulin dosage

• Gradual onset

• Normal activity level


Summary, continued

Treatment for hypoglycemia

• Request medic unit, if indicated

• Maintain airway

• Administer oxygen

• If able to swallow, give oral glucose

• Monitor vital signs and LOC


Summary, continued

Your primary responsibility for a hyperglycemic diabetic is to maintain the airway and provide rapid transport

Guidelines for administering oral glucose

• Ask if able to swallow, if not don’t administer • Position upright • Ask to sip or chew sugar-containing substance • Monitor patient’s response • Repeat blood glucometry

Documents

Copyright 2009 Seattle/King County EMS Overview of CBT 450 Diabetic Emergencies Complete course available at