Download Diabetes

Temple College
EMS Professions
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Required as fuel for cellular metabolism
Brain’s need for glucose parallels its demand
for oxygen
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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
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Located in
retroperitoneal space
Produces, releases
 Digestive enzymes into
duodenum
 Insulin, glucagon into
blood
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Alpha cells
 Glucagon
 Raises blood sugar
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Beta cells
 Insulin
 Lowers blood sugar
Metabolic disease
Characterized by inadequate, absent insulin production
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No insulin production
Takes insulin injections
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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
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Hyperglycemia
 Diabetic ketoacidosis (DKA)
 Hyperosmolar coma
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Hypoglycemia
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Causes
 Failure to take insulin
 Overeating, eating wrong diet
 Stress (fever, infection, emotional stress)
New-onset diabetics usually present
with an episode of hyperglycemia
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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
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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
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Volume depletion
Ketone body production (ketoacidosis)
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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
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Cells continue to burn sugar
Acidic ketone bodies not produced
Nail-polish remover or “fruity” breath odor not
present
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Severe volume depletion
NO ketone body production
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Management
 Support ABC’s
 Treat for hypovolemic shock
 Transport
 IV??
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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?”
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Insulin shock isn’t really shock
Patient just looks “shocky” because of
epinephrine adrenals are releasing
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Can occur in non-diabetics
Most common cause =
empty stomach
A patient is never, just drunk
EtOH on
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Conscious patient
 Give glucose orally
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Unconscious patient
 Support ABC’s !!
 initiate Diabetic Protocol
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Have you eaten today?
Have you taken your medication today?
What other questions can you think of?
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Atherosclerosis
 Myocardial infarction
 CVA
 Peripheral vascular disease
 Blindness
 Renal failure
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Different types of neuropathy:
Peripheral
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Autonomic
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Proximal or Focal
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Toes
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Feet
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Legs
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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
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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
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Diabetic Neuropathy
 Gangrene
 Increased “silent” myocardial infarction risk
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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