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MacAttack wrote:I knew there was a difference but was hoping that a non meter way was available to positively tell the difference.
jimdawg wrote:Kind of bringing up an semi old topic, but as a type 1 diabetic, I have been through and learned a lot about low blood sugars. As far as the comment from sixtey-eight whiskey and rakkfo, You can pick up glucose gels at your local pharmacy and even walmart and kmart carry it too. If you you don't have that luxury, the tubes of gel cake icing work too. Squirt a good shot into the individual's mouth between the lower lip and gums and massage it in. This is the best way to administer glucose to an unconscious diabetic, unless they are carrying a glucagon kit, which is a syringe of solution and a vial of powder. Shoot the solution into the vial, shake it up real good, draw it back out and inject the person. Make sure you inject it into a fatty area like the thighs, stomach, of back of the arms, depending on the build of the person.
JustInCase wrote:How do you know that they are having a low blood sugar episode if they are unconscious? Is there a difference between a high sugar problem and a low sugar problem? Before you give them some kind of treatment wouldn't you want to test the blood first?
MacAttack wrote:Sorry but unless I get training I'm not injecting anyone with anything unless its good old man goo into a happy and willing recipient.
OTTB wrote:"What's that you're wearing?"
"This? Oh, just my rabies hat."
shrapnel wrote:Darling, I would never fondle your sphenoid.
Dr. Cox wrote:People aren't chocolates. Do you know what they are mostly? Bastards. Bastard-coated bastards with bastard fillings.
JamesCannon wrote:Shrapnel, if you were a superhero, you'd be Captain Buzzkill Peener Pain.
shrapnel wrote: And do you have to pulverize the old man yourself, or can you get packets of pre-gooed old man?
shrapnel wrote:MacAttack wrote:Sorry but unless I get training I'm not injecting anyone with anything unless its good old man goo into a happy and willing recipient.
What makes old man goo good or not? And do you have to pulverize the old man yourself, or can you get packets of pre-gooed old man?
jjesusfreak01 wrote:JustInCase wrote:How do you know that they are having a low blood sugar episode if they are unconscious? Is there a difference between a high sugar problem and a low sugar problem? Before you give them some kind of treatment wouldn't you want to test the blood first?
I'm intending this post to be fairly definitive info for diabetic emergencies, so if anyone is interested, read on. I'm a NC EMT-B finishing up training as an EMT-I, so i'm both educated in these treatments and have done them on many occasions. Now, to answer the question...
You probably won't be able to tell the difference between a high/low sugar condition if they are unconscious. A DKA patient (high blood sugar, haven't had their insulin, digesting proteins and forming ketones) may have fruity/acetone/alcohol smelling breath from the production of ketones. A hypoglycemic seizure/coma patient will conceivably have their normal bad breath. Their is a third category of patient who has an extended period of high blood sugar with limited insulin production called HHS, but you may be less likely to see it and it is less dangerous than the other two conditions.
If you have a person who is a known diabetic and has been for a while, they are very unlikely to be in DKA. For a person to go into diabetic ketoacidosis, they have to stop taking their insulin altogether. Sometimes when diabetics get sick they lose the ability to regulate their blood sugar well, ie, they can't control it with standard doses of insulin, in which cases they may need to seek definitive medical care (read: hospital) to prevent HHS.
BLS care (for use in remote environments where emergency care isn't readily available):
Low blood sugar (or hypoglycemia) is by far the most likely blood sugar problem for you to encounter in the field. If you are with the patient start to finish, they may tell you ahead of time they are about to go out (they experience an "aura") and they may seize. These seizures usually last only a few minutes and are not seriously damaging to the patient if they last for only a few minutes. Use standard care for a seizure patient, that is, protect them from injuring themselves on nearby objects. The definitive care for this condition is sugar, whether it be oral, IV, or a PB&J sandwich. If you encounter a patient with suspected hypoglycemia, check their blood glucose if you can. If you are unable to check their sugar, but still have good reason to believe that is the cause, you can attempt to administer oral glucose or a similar substance. Despite what you have been warned, in an emergency situation you can give oral sugar to an semi-conscious patient. The best way to do it is to have them in a sitting position and to place the sugar under their tongue and at the gumline outside their teeth. This prevents them from aspirating the sugar even if they don't have great control of their airway. Keep in mind that some diabetics may rebound back to consciousness after seizing without any assistance, so take care to ensure that the situation warrants using oral glucose.
ALS care (for those with appropriate training in austere/wilderness environments): Glucagon is given IM to a patient when venous access isn't available. It releases glycogen stores from the liver, which are converted to glucose. These patients will still quickly need complex carbohydrates to prevent recurrent hypoglycemia. The glucagon may not even work completely and you may still need to reattempt IV access. If IV access is readily available, consider D50. IV Dextrose (D50) will almost instantaneously raise a person's blood glucose (you are literally injecting sugar into their bloodstream), but will also be short acting. IV dextrose should bring a person out of a diabetic coma even if glucagon does not. It must be followed by making the patient eat complex carbs to prevent recurrent hypoglycemia. The most important thing to remember if giving D50 is that you MUST ensure you are in a vein before pushing it (you'll kill all the tissue around if you inject it into muscle or skin). This can be done by drawing back on the syringe filled with the D50 and seeing blood return.
Again, don't attempt any of these treatments (aside from proper care of a seizing patient) if you have trained medical providers available within 30 minutes via the EMS system. Otherwise healthy diabetic patients rarely keel over, even from serious hypoglycemic episodes.
QuietRiot wrote:...a soda and a good old peanut butter and jelly sammich...
jjesusfreak01 wrote:JustInCase wrote:Their is a third category of patient who has an extended period of high blood sugar with limited insulin production called HHS, but you may be less likely to see it and it is less dangerous than the other two conditions.
croaker260 wrote:One final thought. it may surprise you to know that I have seen more medics injured on diabetic calls than most other call types. Not shootings, not domestic violence, not traffic accidents. Why? Because we conduct ourselves differently (*weather we admit it or not) on these calls where we already assume there is a danger. We would be wrong of course. I have seen normally good normal people swing at paramedics, pulll guns, pull knives, and in one case...body slam an ambulance (yes, the whole ambulance) hard enough to set off the Gforce alarms...all because they were confused and combative.
So, take care of your friend, but be cautious, and treat the emergnecy first, then the underlying problem of the emergency once you are SURE that is what it is.
Krustofski wrote:Dude, you're an open system which has energy pumped into it at least once a day. Entropy doesn't stand a chance. Plus, all living things are thermodynamically unstable anyway, we're held together by pure kinetics. You're not special. Um... what I'm trying to say is: Happy Birthday.
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