It was a few years ago and we were having a great conversation about our favourite topic, hockey.
Being a big Jets fan, he excitedly told me the news that Winnipeg was approved to get their team back.
You could feel the excitement come across the phone: “did you hear the Jets are coming back!?”
Not 30 seconds later, he said it again: “did you hear the Jets are coming back!?”
Umm yeah, we just talked about that.
Then he repeated it again, this time his speech was a little slurred.
Something was off.
Then I clued in and asked: “did you take your insulin this morning?”
“Why would I do that”, his speech was getting more slurred.
“When was the last time you ate?”
“Why would I do that, I don’t need anything!?”
I hung up and started phoning every extension in the office, no one was answering.
I drove to the office and found him slumped over his desk, looking and sounding very confused.
The small sugar drink he had taken wasn’t working, or more likely just wasn’t enough.
I ran next door to the coffee shop and grabbed some food, Coke and orange juice.
When I got back, I held everything up and asked what would work best.
He pointed at the Coke.
I took the top off, handed it to him and he took a sip. He sat up a little, then took another drink. The third drink perked him up some more, with each drink his condition improved.
Then he looked at me and said: “what the hell were we talking about!?”
“Oh yeah, did you hear the Jets are coming back!?”
Understanding Types Of Diabetes
I’m sure we all know someone and have at least a few patients who have diabetes. However it is important to know which type of diabetes they have.
There are two different classifications, although one kind doesn’t get talked about or recognized as much.
- Diabetes Insipidus:
- Results because of dysfunction of the posterior pituitary.
- Causes defects in antidiuretic hormone (ADH) receptors or can’t secrete it.
- Neurogenic Diabetes Insipidus makes too much ADH because of a brain injury.
- Nephrogenic Diabetes Insipidus the kidneys do not respond to ADH which results in too much urination leading to dehydration.
- This type of diabetes is typically treated with hormone therapy.
- Diabetes Mellitus:
- The more common form of diabetes, with classification of Type 1 and Type 2 resulting from an inability to make or use insulin.
- Type 1 referred to as juvenile diabetes or insulin dependent, the persons immune system destroys the beta cells in the pancreas, so they don’t produce insulin.
- People with Type 1 typically have to take insulin injections to deal with the condition.
- Type 2 aka: non-insulin dependent diabetes or adult onset diabetes most commonly caused by cells becoming less sensitive to insulin.
- Type 2 diabetics may need insulin injections but it is typically managed with checking blood sugar and regulating with diet.
Diabetes Mellitus is the condition we are most likely going to be faced with in our clinic, so it is important for us to understand what is happening and how to deal with this if we are ever faced with someone having a diabetic emergency before or after a treatment.
If someone who requires the use of insulin takes too much (hyperinsulinism) this can cause the body to use up any extra glucose in the blood (hypoglycemia), which then deprives the brain of the sugar it needs.
When this happens the brain cannot function properly and the body begins to shut down.
If someone is having this kind of a diabetic reaction, it can eventually lead into a diabetic coma and eventually death if it is not dealt with appropriately.
It is then our responsibility as healthcare professionals to be able to recognize and deal with this, preventing the coma and reversing the reaction.
Signs And Symptoms Of A Diabetic Reaction
If we have a patient with diabetes, chances are it is going to be Type 1 or 2.
Those with Type 2 typically manage their blood sugar with diet and monitoring blood sugar levels (sometimes they use insulin as well). This comes on later in life, usually past the age of 35.
However those with Type 1 (who use insulin) can end up suffering from hyper or hypoglycemia.
If they are experiencing hyperglycemia, there is sugar in their blood, but not enough insulin to allow their cells to be receptive to the sugar.
When this happens the body attempts to get the sugar from other sources, such as fats from within the body. This produces increased waste in the body and knocks pH balance off and the person starts to feel ill.
When the person is experiencing hypoglycemia (not enough sugar), the sugar in the body is used up and in turn affects brain function which can be life threatening.
This can be caused by a few different things:
- Takes too much insulin.
- Hasn’t eaten enough, or regularly enough.
- Exercise has burned off their blood sugar faster than normal.
- Great emotional stress.
In order to recognize a possible emergency, there are similarities between the hyper and hypoglycemic conditions:
- An altered level of consciousness, dizzy, drowsy and confused.
- Rapid breathing.
- Rapid pulse.
- Feeling ill as well as looking ill.
If you know one of your patients has diabetes and starts to show any of these symptoms, it is essential to provide the appropriate care.
Providing Care During A Diabetic Emergency
There are some specific steps to take when trying to help someone during a diabetic emergency.
If you’re not sure why the person is having an issue, we do what is called a Primary Survey. Check to see if they have their ABCs (Airway, Breathing, Circulation). If they are unconscious, call 911.
If they are conscious and speaking to you, then the ABCs are present and you can go into your Secondary Survey.
During the Secondary Survey we do a quick check of the rest of the body to see if there are any injuries that could be causing the issue. It’s just a quick rapid scan of the persons body from head to toe looking for possible injuries.
This is where you could possibly find a medic alert bracelet or necklace that could tell you they are diabetic. Nowadays some people are also getting them as tattoos, so you may see this as well.
Assuming the person can talk to you, then there is a series of questions to use called the SAMPLE questions. It is just a simple mnemonic which can help you determine what is going on:
- S – signs and symptoms?
- A – allergies?
- M – medications?
- P – past medical history?
- L – last meal?
- E – events leading up to the emergency?
In the case of a diabetic emergency, there are a few questions that can really help you out.
If you didn’t already know it was a diabetic emergency, knowing their medication (insulin), past medical history (diabetes) and their last meal can give you great insight into what is going on.
The person might tell you right away what is wrong and ask for something to help, but just in case they don’t, asking those questions can get you the information you need.
Now that you have determined the emergency, we need to get sugar into their system.
Keeping fruit juice, candy or non-diet soft drinks in your clinic are all great resources to help someone in this condition. After they have some sugar, it will help quickly, actually it’s surprising how quickly it can turn things around.
If the person is unconscious, do not give them anything, you could end up compromising the airway and making things worse.
Just monitor their ABCs until further help arrives.
There is a bit of controversy about determining the difference between hyper and hypoglycemic conditions as there could be a concern about giving someone sugar who already has too much sugar in their system.
While this could cause some more damage, it is not going be as life threatening as it is for someone who has low blood sugar and needs to get sugar in their system.
For our purposes in a clinical setting, we are going to treat the person with sugar because it will be difficult to know which condition is causing a problem.
Since we are not authorized to give medications we don’t inject insulin for people. If this happens before a treatment, you cannot carry on with the massage even if the patient has some sugar and starts to feel better. They need to go eat a proper meal to help balance out blood sugar. It doesn’t mean they need to go to the hospital (unless they don’t start to feel better within five minutes of getting sugar in their system), remember this is something they deal with on a regular basis (if they go unconscious, call 911). Since 9.3% of the population has diabetes and a large population remains undiagnosed, as well as the prevalence of gestational diabetes affecting 9.2% of pregnant women, there is a strong chance you will have to deal with this kind of an emergency in your clinic one day. Knowing the signs, symptoms and ways to deal with it will be the biggest way you can help any one of your patients should this happen. And yes, the Jets came back and I still get to talk to my buddy about it regularly.