Chapter 20

Acute Diabetic Emergencies

Prehospital Emergency Care, Ninth Edition

Joseph J. Mistovich Keith J. Karren

Copyright 2010 by Pearson Education, Inc.

All rights reserved.

Understanding
Diabetes Mellitus

Back to Topics

Glucose (Sugar)

Back to Objectives

 Sources
Roles
Brain cells

Hormones That Control Blood

Glucose Levels

Insulin

Back to Objectives

Insulin

Main functions
How it works

Hormones That Control Blood

Glucose Levels

Glucagon

Glucagon

Role
Functions

Hormones That Control Blood

Glucose Levels

Other Hormones

Epinephrine
Released by the adrenal glands
Stops the secretion of insulin
Promotes release of stored glucose from
the liver
Promotes conversion of other substances
into glucose

Normal Metabolism and

Glucose Regulation

Back to Objectives

Normal Glucose
Regulation

Checking the Blood Glucose Level

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Diabetes Mellitus (DM)

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 Primary problem
Type I diabetes
Type II diabetes

Information about Diabetes

Click here to view a video on information about diabetes.

Return to Directory

Acute Diabetic
Emergencies

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Hypoglycemia

Pathophysiology of
Hypoglycemia

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 Cause
Reasons for drop

Pathophysiology

Hypoglycemia

Assessment Findings in
Hypoglycemia and
Hypoglycemia Unawareness

Assessment
Findings

Back to Objectives

Cause
Signs and symptoms
Hypoglycemia
unawareness

Hypoglycemia

Emergency Medical
Care for Hypoglycemia

Emergency
Medical Care

For a responsive patient

For an unresponsive patient

Oral Glucose

Back to Objectives

 Purpose for administration

Criteria for administration

Hyperglycemia

Back to Objectives

 Hyperglycemia
Diabetic ketoacidosis (DKA)
Hyperglycemic hyperosmolar nonketotic
syndrome (HHNS)

Hyperglycemic Condition: Diabetic

Ketoacidosis (DKA)

Pathophysiology of DKA

Pathophysiology

Cause
Results in the body
Factors causing
hyperglycemia in
DKA patients
Back to Objectives

Hyperglycemic Condition: Diabetic

Ketoacidosis (DKA)

Assessment Findings
in DKA

Assessment
Findings

Signs and symptoms

Polyuria
Polydipsia
Polyphagia

Kussmauls respirations
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Hyperglycemic Condition: Diabetic

Ketoacidosis (DKA)

Emergency Medical
Care for DKA

Emergency Medical
Care

ABCs
Provide O2
Assist ventilation
Check BGL
Contact medical direction

Hyperglycemic Condition:
Hyperglycemic Hyperosmolar
Nonketotic Syndrome (HHNS)

Pathophysiology of HHNS

Back to Objectives

Pathophysiology

Blood glucose level

Precipitating factors

Hyperglycemic Condition:
Hyperglycemic Hyperosmolar
Nonketotic Syndrome (HHNS)

Assessment Findings
in HHNS

Back to Objectives

Assessment
Findings

Signs and symptoms

Emergency
Medical Care

ABCs
Provide O2
Support respirations
Determine BGL
Medical direction

Assessment-Based
Approach: Altered
Mental Status in a
Diabetic Emergency

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Scene Size-Up and Primary

Assessment

Back to Objectives

Look for scene clues

Medic alert tags
Insulin pumps

History and Secondary

Assessment

 SAMPLE
Common
medications
Questions to ask

History and Secondary Assessment

Signs and Symptoms

Signs and Symptoms

Place redrawn picture 2009 here did not have
yet, WDS

Emergency Medical Care

 ABCs
Determine if patient can
swallow
Administer oral glucose
Transport

Reassessment

May take 20 minutes to see improvement

Recheck BGL
Continue O2
Manage airway as needed

CASE STUDY

Follow-Up

CASE STUDY
Primary Assessment
Patient sitting on couch
Find Digoxin in kitchen and insulin
in refrigerator
Patient is pale and sweating
profusely
Patient speaking in mumbled words

CASE STUDY
Primary Assessment
Partner places a nonrebreather
mask at 15 lpm
RR: 15; P: 100 and strong

CASE STUDY
Secondary Assessment
Do rapid assessment
BP: 102/60 mmHg; P: 108; RR:16;
skin pale, cool, and moist; SpO 2: 97
percent
BGL: 48mg/dL
Administer one tube of glucose
Place patient in left lateral position

CASE STUDY
Treatment and Reassessment
Becomes oriented to name and
place
Pulse rate, skin, and SpO2 improve
Change over to nasal cannula
Alert and oriented upon arrival
Transfer care without incident

Critical Thinking Scenario

34-year-old female with an altered mental
status
Responds to painful stimuli only with
moans
A neighbor called 911 after finding her on
the couch and not responding

Critical Thinking Scenario

S Supine on the couch, not alert
A Unknown
M Her neighbor brings you the patients
medications: Zoloft and Novolin
P Her neighbor doesnt know the patients
medical history
L Unknown
E Patient called the neighbor 20 minutes
ago and said she wasnt feeling well

Critical Thinking Scenario

Vital signs:
BP: 108/62 mmHg
HR: 122 bpm
RR: 12 per minute with snoring
respirations but adequate chest rise
Skin is pale, cool, and very diaphoretic

Critical Thinking Questions

1. What emergency care would you provide
during the primary assessment?
2. Based on the signs, what condition do
you suspect the patient is experiencing?
3. What other assessment procedures
would be helpful to you for this patient?
4. What would you expect the blood
glucose reading to be in the patient?
5. Why is the onset of the altered mental
status significant in this patient?

Reinforce and Review

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