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Power Points for EMS Education
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Barry Kidd 2010 1
Diabetes
HOW SWEET ARE YOU?
Barry Kidd 2010 2
Diabetes
Diabetes is a disease caused by the inadequate production of insulin
Insulin Shock (hypoglycemia at it’s worse case) results from too much insulin in the blood, causing low sugar levels for the brain and nervous systems
Diabetic Coma (hyperglycemia at it's worse case) results from an inadequate insulin supply that leads to unconsciousness, coma and death if not treated
Barry Kidd 2010 3
Diabetes is Managed,But it Does Not Go Away.
GOAL:
To maintain target blood
glucose
Barry Kidd 2010 4
Diabetic Coma (Hyperglycemia)
Hyperglycemia is a lack of insulin, this causes too much sugar in the blood and not enough in the cells
Causes: Too much food Not taken insulin Insulin facilitates the transport of sugar
Barry Kidd 2010 5
Diabetic Coma (Hyperglycemia)
Barry Kidd 2010 6
Diabetic Coma (Hyperglycemia)
Signs and Symptoms… Rapid deep breathing Rapid weak pulse Decreased level of consciousness Dehydrated (dry), warm skin Sweet or fruity, (acetone) odor on breath Dry mouth and intense thirst Increasing restlessness, confusion This onset of this condition is gradual over
a period of days
Barry Kidd 2010 7
Diabetic Coma (Hyperglycemia)
Care for the Patient… Keep at rest in position of comfort Obtain a good history (meals, insulin) High flow O2 Reassurance If unsure whether insulin shock or diabetic coma, give
glucogel or instagel if patient has a patent airway Monitor vital signs Transport the patient to advanced medical care
Barry Kidd 2010 8
Insulin Shock (Hypoglycemia)
There is too much insulin, causing a lack of sugar in the blood.
Some causes are: Not enough food Too much insulin Excessive exerciseInsulin facilitates the transport of sugar
Barry Kidd 2010 9
Insulin Shock (Hypoglycemia)
Barry Kidd 2010 10
Insulin Shock (Hypoglycemia)
Signs and Symptoms… Normal breathing Rapid, full pulse Decreased or altered level of consciousness Pale, moist skin (sweaty at times) Dizziness, headache Fainting Seizures Disorientation Coma This onset of this condition is sudden, can occur
within minutes
Barry Kidd 2010 11
Insulin Shock (Hypoglycemia)
Care for Patient Keep at rest – position of comfort S-A-M-P-L-E history (Insulin, meals, etc.) High flow O2 Monitor vital signs Nothing by mouth, unless their alert If unsure whether insulin shock or diabetic
coma, give the patient instagel or glucogel Transport patient to advanced care
Barry Kidd 2010 12
Constant Juggling:
Insulin/medication
with:
Exercise
Food intake
Diabetes Management 24/7
BGBG
BGBG
BGBG&
Barry Kidd 2010 13
Diabetes
Gestational diabetes
Some women may develop gestational diabetes during pregnancy. These women are non-symptomatic before the pregnancy. Generally, glucose levels will return to normal after the pregnancy, although there is a higher risk of developing diabetes later in life
Barry Kidd 2010 14
Diabetes
There are many risk factors for diabetes, including:
A parent, brother, or sister with diabetesobesity Age greater than 45 yearsSome ethnic groups (particularly African-
Americans, and First Nation)
Barry Kidd 2010 15
Diabetes
Gestational diabetes or delivering a baby weighing more than 9 pounds
High blood pressure High blood levels of triglycerides (a type
of fat molecule)High blood cholesterol level
Barry Kidd 2010 16
Diabetes
Measuring Glucose Level
Blood Glucose Level (BGL) is measured in millimoles per litre (mmol/l), and a normal BGL ranges from 4 mmol/l to 7 mmol/l. Hypoglycemia is most often defined as a BGL of less than 4 mmol/l, whereas hyperglycemia is defined as a BGL of greater than 7 mmol/l.
Barry Kidd 2010 17
Diabetes
To accurately check someone’s BGL, use a device called a glucometer. Use this reading, along with a patient’s history and any signs and symptoms found during assessment, to determine whether to treat the situation as a diabetic emergency.
Barry Kidd 2010 18
Diabetes
How to use the GlucometerPrepare the lancet and lancet deviceLet the patient’s arm hang to the side if
possibleRemove a new test strip from the vial
and insert it into the deviceMatch the code number on the screen to
that of the test strip vial
Barry Kidd 2010 19
Diabetes
Cleanse the finger and force blood to the finger by squeezing the finger
Prick the side of the finger and gently squeeze out a drop of blood
Drop the blood onto the test strip in the appropriate place, cover lancet site with a Band-Aid
Record the BGL reading Remove the test strip and dispose into a
biohazard bag
Barry Kidd 2010 20
QUESTIONS
51481: Which of the following is a common sign or symptom of a patient experiencing a diabetic emergency?
A: Slow pulse
B: Pale, clammy skin
C: Elevated blood pressure
D: Decreased respiratory rate
Barry Kidd 2010 21
ANSWERS
B: Pale, clammy skin
Barry Kidd 2010 22
QUESTIONS
2: Altered mental status that often accompanies diabetic emergencies is often mistaken for:A: a migraine.
B: alcohol intoxication.
C: a severed spinal cord.
D: a swollen or deformed lower extremity.
Barry Kidd 2010 23
ANSWER
B: alcohol intoxication.
Barry Kidd 2010 24
QUESTIONS
3: Diabetes is considered a disease of balance because the patient must try to balance:A: food intake with glucose therapy.
B: medication with charcoal intake.
C: medication to stimulate the liver with fat intake.
D: the need for glucose with the available insulin supply.
Barry Kidd 2010 25
ANSWER
A: food intake with glucose therapy.
Barry Kidd 2010 26
QUESTIONS
4: Which of the following conditions can occur if an unconscious patient is given oral glucose?A: Shock
B: Aspiration
C: Hypotension
D: Hyperglycemia
Barry Kidd 2010 27
ANSWER
B: Aspiration
Barry Kidd 2010 28
QUESTIONS
5: Diabetes is caused by the body's lack of adequate amounts of:A: sugar.
B: insulin.
C: glucose.
D: aspartame.
Barry Kidd 2010 29
ANSWER
B: insulin.
Barry Kidd 2010 30
QUESTIONS
6: The form of diabetes that develops as a person ages is called:A: type I diabetes.
B: type II diabetes.
C: type III diabetes.
D: adult sugar disorder.
Barry Kidd 2010 31
ANSWER
B: type II diabetes.
Barry Kidd 2010 32
QUESTIONS
7: Which of the following will probably NOT cause a diabetic emergency in a patient with a history of diabetes controlled by medication? A: Eating a regularly scheduled meal
B: Unusual exercise or fatigue
C: Overeating
D: Infection
Barry Kidd 2010 33
ANSWER
A: Eating a regularly scheduled meal
Barry Kidd 2010 34
QUESTIONS
8: Oral glucose should be placed:A: on the tongue of a conscious patient.
B: on the tongue of an unconscious patient.
C: between the cheek and gum of a conscious patient.
D: between the cheek and gum of an unconscious patient.
Barry Kidd 2010 35
ANSWER
C: between the cheek and gum of a conscious patient.
Barry Kidd 2010 36
QUESTIONS
9: The term "polyuria" can be defined as frequent: A: seizure activity.
B: bouts of depression.
C: Urinating excessively.
D: drinking to satisfy continuous thirst.
Barry Kidd 2010 37
ANSWER
C: Urinating excessively.
Barry Kidd 2010 38
QUESTIONS
10: What waste products are formed when fat is used for energy? A: Pancreatic acids
B: Glucose and carbon dioxide
C: Glucose and fatty acids
D: Ketones and fatty acids
Barry Kidd 2010 39
ANSWER
D: Ketones and fatty acids
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