Diabetic Emergencies
Definition of Diabetes Mellitus (DM)
A chronic disorder characterized by a deficiency of insulin secretion and/or insulin effect, which causes hyperglycemia, disturbances of carbohydrate, fat and protein metabolism
Most diabetics adequately manage the disease and maintain stable blood sugar levels. Normal glucose range of 70 to 110 mg/dl (3.9 to 6.1 mmol/L)
Normal insulin metabolism
ü Produced by the b cells in the islets of Langerhans of the pancreas
ü Facilitates normal glucose range of 70 to 120 mg/dl (3.9 to 6.66 mmol/L)
ü Promotes glucose transport from the bloodstream across the cell membrane to the cytoplasm of the cell
ü Insulin after a meal:
o Stimulates storage of glucose as glycogen
o Inhibits gluconeogenesis ( the formation of sugar from protein or fat)
ü Insulin after a meal:
o Enhances fat deposition in adipose tissue
o Increases protein synthesis
Types of Diabetes Mellitus
• Type I; insulin dependent
• Type II; Non-insulin dependent
• Gestational diabetes
• Diabetes mellitus associated with other conditions
Diabetes type I (Insulin dependent DM):
Formerly known as “juvenile onset” or “insulin dependent” diabetes
• Most often occurs in people under 30 years of age
• Peak onset between ages 11 and 13
• Progressive destruction of pancreatic b cells
• Autoantibodies cause a reduction of 80% to 90% of normal b cell function before manifestations occur
• Causes:
– Genetic predisposition
• Related to human leukocyte antigens (HLAs)
– Exposure to a virus
v Onset of Type I DM:
• Manifestations develop when the pancreas can no longer produce insulin
– Rapid onset of symptoms
– Present at ER with ketoacidosis
Type 2 Diabetes Mellitus
• Accounts for 90% of patients with diabetes
• Usually occurs in people over 40 years of age
• 80% to 90% of patients are overweight
Patrhophysiology:
§ Pancreas continues to produce some endogenous insulin
§ Insulin produced is either insufficient or poorly utilized by the tissues
§ Insulin resistance
• Body tissues do not respond to insulin
• Results in hyperglycemia
§ Impaired glucose tolerance (IGT)
• Occurs when the alteration in b cell function is mild
• Blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes
§ Inappropriate glucose production by the liver
• Not considered a primary factor in the development of type 2 diabetes
§ Insulin resistance syndrome (syndrome X)
• Cluster of abnormalities that act synergistically to the risk of cardiovascular disease
Onset of Type 2 DM:
§ Gradual onset
§ Person may go many years with undetected hyperglycemia
§ Marked hyperglycemia (500 to 1000 mg/dl)
Gestational Diabetes
• Develops during pregnancy
• Detected at 24 to 28 weeks of gestation
• Risk for cesarean delivery, perinatal death, and neonatal complications
Secondary Diabetes
• Results from another medical condition or due to the treatment of a medical condition that causes abnormal blood glucose levels
– Cushing syndrome
– Hyperthyroidism
– Parenteral nutrition
Causes of DM
Ø Body does not make or properly use insulin:
Ø no insulin production
Ø insufficient insulin production
Ø resistance to insulin’s effects
Ø No insulin to move glucose from blood into cells
Clinical Manifestations of DM
• Three Ps”
§ Polyuria
§ Polydypsia
§ Polyphagia
Risk factors
Insulin therapy
• Administration of insulin
– Cannot be taken orally
– SQ injection for self-administration
– IV administration
There are two different categories of emergencies when it comes to diabetes:
Hyperglycemia
Hyperglycemia (high blood sugar)- onset of this condition is slow, and may occur when the diabetic consumes a large amount of sugar when they are inactive. The onset of a diabetic coma from insufficient insulin is usually gradual and therefore unlikely to reach crisis stage. Blood sugar levels elevate as the condition progresses, leading to severe hyperglycemia (ketoacidosis).
Symptoms include:
- Hot dry skin.
- Excessive thirst.
- Frequent need to urinate.
- Smell of acetone (nail polish remover) on the persons breath
- Drowsiness
- Unconsciousness, which may lead into diabetic coma if untreated
- Blurred vision
First aid of Hyperglycemia
- Do not give the person something sweet to eat or drink as it will raise their blood sugar.
- If the person is conscious and able, allow them to give themselves an insulin injection.
- call a 199 or bring the person to the ER if blood sugar is abnormally high, or if person is unconscious.
- If help is delayed, give the person sugar free liquids.
Hypoglycemia
Hypoglycemia (low blood sugar)- the onset of this imbalance is usually rapid, and commonly happens when the diabetic is physically active, took large dose of insulin, or did not eat. A plasma glucose value below 45 mg/dl identifies hypoglycemia.
Signs of hypoglycemia
- Pale, cold, and moist skin.
- Weak and tired
- Dizziness and confused (may act drunk)
- Hungry
- Excessive sweating
- Rapid pulse
- Headache
- Seizure
- Shakes or trembling
- May go to sleep and become unconscious
Treatment for Hypoglycemia
1. A diabetic should always try to carry something sweet with them, a non-diet soda, fruit, or some candy in case they go ‘low’. Administering this sweet drink or food item will help reverse the effects of hypoglycemia and raise the persons’ blood sugar levels. Glucose tabs and gels are available in most drugstores. Only give food or drink if the person is conscious.
2. Do not let a recovering victim resume normal activity too quickly.
3. If the person loses consciousness or cannot swallow then medical assistance is needed. Call 911 immediately or take the person to the ER.
4. If the person goes into a seizure, provide first aid for seizure.
5. There is an injectable medication called glucagon, which is available by prescription. Administer this injection if you know how to do it, which raises the blood sugar quickly. 1-1mg of glucagon im if available at home.