Diabetes Basics

EMS Training

by mobrian on June 9, 2009

Diabetes is a disease that, at its most basic, is the body not producing enough insulin or is unable to use the insulin it has properly.

By Alan Ramsey

Let’s start with the key player, Insulin, it is the hormone needed for the body to convert food, sugars and starches mainly, into energy.  An easy way to look at it is to see insulin as the key that allows the sugars (glucose) into the cells.  Without it the glucose level in the blood will be high and the available glucose in the cells will be low.  Without the key the glucose can’t enter the cells.  As we will see this shifts the whole body out of balance.

Statistically speaking, approximately 18 million adults and children have been diagnosed.  While another 5.7 million are unaware that they too have diabetes, bringing the total over 23 million people with diabetes.

Diagnosis is quick and relatively inexpensive.  The American Diabetes Association recommends the Fasting Plasma Glucose Test (FPG) due to its easy and accessibility.  The results range from: normal 80-100, 100-125 is pre-diabetic & over 126 is confirmed diabetes.

An estimated 57 million undiagnosed people fall into the pre-diabetic category.  Why is this important to the EMS provider?  These are the people you see for a variety of complaints relating to diabetes, but will tell you they don’t have it.  While it’s not our place to diagnose them it is our job to care for them in the best manner possible.  So be aware of the signs and take a critical look at the patients you care for.

Aside from our pre-diabetics there are three main types of diabetes.

Type 1 Diabetes is a result of the body’s failure to produce insulin. Insulin is produced by the Beta cells of the Islets of Langerhans in the pancreas.
The treatment options are limited.  Typically insulin must be given by injection or pump through the skin in sufficient amounts to regulate the blood glucose levels.  FYI, the inhaled insulin is no longer on the market; it couldn’t compete from a business standpoint.

Type 2 Diabetes is the result of insulin resistance or reduced insulin sensitivity.  The body fails to produce sufficient insulin to control the blood glucose levels.

This type has a variety of treatment options.  Most often diet and exercise plans are initiated to help maximize the body’s potential to make its own insulin.  If these are unsuccessful then medications can be added, sometimes multiple medications are used to both increase production and maximize use of insulin.

Factors that predispose a person to diabetes are: age, family history (genetics), environmental exposures (bisphenol, a constituent of polycarbonate plastic is shown a correlation to Type 2 when elevated levels are present in the urine) and “central obesity,” this is the dreaded spare tire around the midsection.  Abdominal fat is hormonally active secreting a group of hormones called adipokines which are believed to impair glucose tolerance.

Gestational Diabetes is most often a sub-type of Type 2.  It occurs during pregnancy and remains a health condition for approximately 5-10%of women.  It is estimated that 20-50% of the affected women will develop Type 2 diabetes later in life.

Treatments are similar to Type 1 or 2 respectively with great care to regulate as well as possible in order to avoid fetal injury.

Signs & Symptoms and Diabetic Issues

When assessing the patient look for recent changes in their daily routine or dietary needs.  There is a triad of symptoms that are associated with the onset of diabetes.  Type 1 has a more rapid progression where Type 2 is more subtle and often undetectable.  They are polyuria (frequent urination), polydipsia (frequent thirst) and polyphagia (increased appetite).  These S/S may be of more interest in a patient with a vague complaint.  For those with an acute issue these will matter less.

Significant issues for the diabetic patient.

Insulin Reaction (Insulin Shock): This occurs when there is too much insulin in the blood.

S/S include: rapid breathing & pulse, dizzy, weak, sweating, headache, numbness to hands & feet, hunger, vision changes and a change in level of consciousness.

Treatment is to provide sugar in whatever form is appropriate. If the patient is conscious any oral sugar is good, if choking is a concern then IV dextrose or IM glucagon are excellent options.

Diabetic Coma: This is the opposite.  There is too much sugar in the blood. There is typically a slower progression than in an insulin reaction as well.
S/S include: thirst, deep & fast breathing (Kussmaul breathing), change in level of consciousness, fever, dehydration and a sweet/fruity smell to the breath (acidosis).

Treatment is limited in the field. Acidosis provides the fruity smell as the body tries to remove extra ketones through the lungs.  The condition is called Diabetic Ketoacidosis (DKA). These patients need insulin.  As first responders we can assist them in whatever physical needs they may have and provide IV 0.9NS bolus to dilute the concentration and easy the dehydration until arrival at the hospital.

Long Term Considerations

Serious and potentially life threatening complications can occur from uncontrolled diabetes and need to be considered when educating the people we come in contact with. The risk of cardiovascular disease (cardiomyopathy) is doubled, the potential for renal failure (nephropathy) is increased, damage to the retinas (retinopathy), many types of nerve damage (neuropathy), erectile dysfunction and other microvascular damage.  This includes longer healing time after an injury or cut and the increased potential for injury due to poor sensation from the neuropathy.

Stipulation

As with anything you read this not everything you should ever know about diabetes.  Please take the time to read and know your local protocols (they will set you free) as well as your department/employers rules and regulations.  Knowing your capabilities will help you be a better EMS provider and an asset to the community and your department.

Bibliography

www.diabetes.org
www.medicinenet.net
www.survival-center.com
www.wikipedia.org

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