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Temple College EMS Professions Required as fuel for cellular metabolism Brain’s need for glucose parallels its demand for oxygen Hormone Produced by Islets of Langerhans in pancreas Required for sugar to enter most cells Brain does not require insulin to use sugar Located in retroperitoneal space Produces, releases Digestive enzymes into duodenum Insulin, glucagon into blood Alpha cells Glucagon Raises blood sugar Beta cells Insulin Lowers blood sugar Metabolic disease Characterized by inadequate, absent insulin production No insulin production Takes insulin injections 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 Hyperglycemia Diabetic ketoacidosis (DKA) Hyperosmolar coma Hypoglycemia Causes Failure to take insulin Overeating, eating wrong diet Stress (fever, infection, emotional stress) New-onset diabetics usually present with an episode of hyperglycemia 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 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 Volume depletion Ketone body production (ketoacidosis) 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 Cells continue to burn sugar Acidic ketone bodies not produced Nail-polish remover or “fruity” breath odor not present Severe volume depletion NO ketone body production Management Support ABC’s Treat for hypovolemic shock Transport IV?? Causes Insulin overdose Normal insulin use without eating Over-exercise 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?” Insulin shock isn’t really shock Patient just looks “shocky” because of epinephrine adrenals are releasing Can occur in non-diabetics Most common cause = empty stomach A patient is never, just drunk EtOH on Conscious patient Give glucose orally Unconscious patient Support ABC’s !! initiate Diabetic Protocol Have you eaten today? Have you taken your medication today? What other questions can you think of? Atherosclerosis Myocardial infarction CVA Peripheral vascular disease Blindness Renal failure Different types of neuropathy: Peripheral Autonomic Proximal or Focal Toes Feet Legs Hands & Arms Nerve damage will likely occur to feet and legs first. S/S?? Numbness or insensitivity to pain, tingling or burning or oversensitivity to touch Affects nerves that control the heart, regulate blood pressure and blood glucose. Also affects other internal organs causing problems with digestion, respiratory function, urination, sexual ability and vision Diabetic Neuropathy Gangrene Increased “silent” myocardial infarction risk Acute MI in diabetic can present without chest pain May resemble “flu” Manage “sick” diabetics as if critically ill until proven otherwise