Diabetes

1
Diabetes

• Temple College
• EMS Professions

2
Glucose

• Required as fuel for cellular metabolism
• Brains need for glucose parallels its demand for
  oxygen

3
Insulin

• Hormone
• Produced by Islets of Langerhans in pancreas
• Required for sugar to enter most cells
• Brain does not require insulin to use sugar

4
Pancreas

• Located in retroperitoneal space
• Produces, releases
• Digestive enzymes into duodenum
• Insulin, glucagon into blood

5
Islets of Langerhans

• Alpha cells
• Glucagon
• Raises blood sugar
• Beta cells
• Insulin
• Lowers blood sugar

6
Diabetes Mellitus

• Metabolic disease
• Characterized by inadequate, absent insulin
  production

7
Type I Diabetes

• No insulin production
• Takes insulin injections

8
Type II Diabetes

• 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

9
Problems in Diabetes
10
Blood Sugar Imbalance

• Hyperglycemia
• Diabetic ketoacidosis (DKA)
• Hyperosmolar coma
• Hypoglycemia

11
Hyperglycemia

• Causes
• Failure to take insulin
• Overeating, eating wrong diet
• Stress (fever, infection, emotional stress)

New-onset diabetics usually present with an
episode of hyperglycemia
12
Diabetic Ketoacidosis

• 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

13
Diabetic Ketoacidosis

• 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

14
Diabetic Ketoacidosis

• Volume depletion
• Ketone body production (ketoacidosis)

15
Hyperosmolar Coma

• 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

16
Hyperosmolar Coma

• Cells continue to burn sugar
• Acidic ketone bodies not produced
• Nail-polish remover or fruity breath odor not
  present

17
Hyperosmolar Coma

• Severe volume depletion
• NO ketone body production

18
Hyperglycemia

• Management
• Support ABCs
• Treat for hypovolemic shock
• Transport
• When in doubt, give sugar!

19
Hypoglycemia

• Causes
• Insulin overdose
• Normal insulin use without eating
• Over-exercise

20
Hypoglycemia
Pale, cool skin sweating nausea tachycardia
Is that why hypoglycemia sometimes is called
Insulin Shock?
21
Hypoglycemia

• Insulin shock isnt really shock
• Patient just looks shocky because of
  epinephrine adrenals are releasing

22
Hypoglycemia

• Can occur in non-diabetics
• Most common cause EtOH on
  empty stomach
• A patient is never, just drunk

23
Hypoglycemia Management

• Conscious patient
• Give sugar orally
• Unconscious patient
• Support ABCs
• Get ALS back-up for IV glucose
• When in doubt, Give Sugar!

24
Ask All Diabetics

• Have you eaten today?
• Have you taken your medication today?
• When in doubt, give Sugar!

25
Other Diabetes Complications

• Atherosclerosis
• Myocardial infarction
• CVA
• Peripheral vascular disease
• Blindness
• Renal failure

26
Other Diabetes Complications

• Diabetic Neuropathy
• Gangrene
• Increased silent myocardial infarction risk

27
Silent MI

• Acute MI in diabetic can present without chest
  pain
• May resemble flu
• Manage sick diabetics as if critically ill
  until proven otherwise