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Diabetes
Temple College
EMS Professions
Glucose


Required as fuel for cellular metabolism
Brain’s need for glucose parallels its
demand for oxygen
Insulin


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Hormone
Produced by Islets of Langerhans in
pancreas
Required for sugar to enter most cells
Brain does not require insulin to use
sugar
Pancreas


Located in
retroperitoneal space
Produces, releases
– Digestive enzymes
into duodenum
– Insulin, glucagon into
blood
Islets of Langerhans

Alpha cells
– Glucagon
– Raises blood sugar

Beta cells
– Insulin
– Lowers blood sugar
Diabetes Mellitus
Metabolic disease
Characterized by inadequate,
absent insulin production
Type I Diabetes
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
No insulin production
Takes insulin injections
Type II Diabetes

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Inadequate insulin production
Increased tissue resistance to insulin effects
Controlled with
– Diet
– Oral medications:
• Diabeta, Diabinese, Dymelor, Glucotrol,
Micronase, Orinase, Tolinase, Glucophage
– Insulin injections as disease progresses
Problems in Diabetes
Blood Sugar Imbalance

Hyperglycemia
– Diabetic ketoacidosis (DKA)
– Hyperosmolar coma

Hypoglycemia
Hyperglycemia

Causes
– Failure to take insulin
– Overeating, eating wrong diet
– Stress (fever, infection, emotional stress)
New-onset diabetics usually present
with an episode of hyperglycemia
Diabetic Ketoacidosis
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Usually Type I diabetic (no insulin)
Blood sugar rises
Kidneys try to remove excess sugar
Urine production increases (polyuria)
Patient becomes volume depleted
–
–
–
–
Thirst (polydypsia)
Tachycardia
Hypotension
Dry skin, mucous membranes
Diabetic Ketoacidosis

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Cells cannot burn sugar; patient experiences
hunger (polyphagia)
Cells burn fat as alternative fuel
Acidic ketone bodies produced
Patient tries to correct acidosis; exhales CO2
Rapid, deep breathing (Kussmaul respirations)
Exhaled ketone bodies produce nail-polish
remover or “fruity” breath odor
Diabetic Ketoacidosis


Volume depletion
Ketone body production (ketoacidosis)
Hyperosmolar Coma

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

Usually Type II diabetic (inadequate insulin)
Blood sugar rises
Kidneys try to remove excess sugar
Urine production increases (polyuria)
Patient becomes volume depleted
–
–
–
–
Thirst (polydypsia)
Tachycardia
Hypotension
Dry skin, mucous membranes
Hyperosmolar Coma



Cells continue to burn sugar
Acidic ketone bodies not produced
Nail-polish remover or “fruity” breath odor not
present
Hyperosmolar Coma


Severe volume depletion
NO ketone body production
Hyperglycemia

Management
– Support ABC’s
– Treat for hypovolemic shock
– Transport
– When in doubt, give sugar!
Hypoglycemia

Causes
– Insulin overdose
– Normal insulin use without eating
– Over-exercise
Hypoglycemia
Blood Sugar Falls
Brain lacks adequate glucose
Adrenal Glands release Epinephrine
Alterations in consciousness;
Seizures; Headache;
Unusual Behavior
Pale; Cool skin;
Sweating; Tachycardia;
Increased BP; Nausea
Pale, cool skin; sweating; nausea; tachycardia
Is that why hypoglycemia sometimes is called
“Insulin Shock?”
Hypoglycemia
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
Insulin shock isn’t really shock
Patient just looks “shocky” because of
epinephrine adrenals are releasing
Hypoglycemia
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Can occur in non-diabetics
Most common cause =
EtOH on empty stomach
A patient is never, just drunk
Hypoglycemia Management
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Conscious patient
– Give sugar orally

Unconscious patient
– Support ABC’s
– Get ALS back-up for IV glucose
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When in doubt, Give Sugar!
Ask All Diabetics
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Have you eaten today?
Have you taken your medication today?
When in doubt, give Sugar!
Other Diabetes Complications

Atherosclerosis
– Myocardial infarction
– CVA
– Peripheral vascular disease
– Blindness
– Renal failure
Other Diabetes Complications

Diabetic Neuropathy
– Gangrene
– Increased “silent” myocardial infarction risk
Silent MI
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Acute MI in diabetic can present without
chest pain
May resemble “flu”
Manage “sick” diabetics as if critically ill
until proven otherwise