Diabetes Emergencies Training Session

1. Skills Training Session February 11, 2014

2. Agenda • Quiz • Run report guidelines, feedback • Scenario • Debrief • Diabetic Emergencies

3. Run Reports • Return reports from last week • Run report cards • Neatness, clarity, completeness • Questions?

4. Scenario • 23 y.o. M/F @ [Location] c/c dizziness.

5. Diabetic Emergencies • Diabetes mellitus • Type 1: insulin-dependent • Hereditary • Need for daily insulin injections • Type 2: non insulin-dependent • Patient produces inadequate amounts of insulin or is resistant • Controlled by diet or oral hypoglycemic drugs • Normal range for blood glucose is 80-120 mg/dL

6. Diabetic Emergencies • Hypoglycemia: • Blood glucose level <80 mg/dL • Can lead to insulin shock • Pale, moist skin • Dizziness, altered LOC • Hunger • Seizure, coma, death

7. Diabetic Emergencies • Hyperglycemia: Blood glucose 120-400 mg/dL • Diabetic keto-acidosis (DKA) 400-800 mg/dL • Diabetic coma possible above 800 mg/dL • Symptoms: • Kussmaul respirations: deep, labored breathing • Rapid, weak pulse • Fruity breath • Altered LOC/unresponsiveness • Dry, warm skin

8. Diabetic Emergencies • DKA and insulin shock appear very similarly, how do we tell the difference? • SKIN SIGNS! “hot and dry, my sugar is high. Pale and clammy, need some candy” • Appears similar to EtOH

9. Diabetic Emergencies • Treatment: • Oral glucose, given to a patient with a decreased level of consciousness with a Hx of diabetes • One dose is one tube • Squeeze onto tongue depressor or swab and spread inside Pt’s cheek. • Never stick your finger’s in a patients’ mouth • Pt must have a gag reflex and be conscious • Low LOC, Pt may lose gag reflex • O2 via NRB, 15 L/min

10. Diabetic Emergencies • Treatment: • If Pt is unconscious, do not try to give glucose. • Maintain airway and transport, Pt needs IV glucose.

11. THANK YOU