Most of us know someone who has diabetes. According to the American Diabetes Association approximately seven per cent of the population has the disease in one form or another.
Diabetes is a disease in which the body either doesn’t produce, or doesn’t properly use, insulin. Insulin is a hormone that is needed to convert sugar, starches and other foods into energy.
The exact cause of diabetes is still unknown but genetics, as well as environmental factors such as obesity and lack of exercise, appear to be contributing factors.
There are two major types of diabetes. Type 1 diabetes affects an estimated 10 to 20 per cent of people with the disease and results from the body’s complete inability to produce insulin. Type 2 is the most common form and results from the body’s failure to properly use insulin.
People who take insulin to control diabetes are subject to two very different types of emergencies. Insulin reaction (also known as insulin shock) occurs when there is too much insulin in the body as a result of the patient over medicating, not eating or exercising heavily. This condition rapidly reduces the level of sugar in the blood (hypoglycemia) and the brain cells begin to suffer.
Signs and symptoms of insulin shock include fast breathing, racing pulse, dizziness, weakness a change in the level of consciousness, vision difficulties, sweating, headache, numb hands or feet and hunger.
Diabetic coma is the exact opposite of insulin shock and occurs when there is too much sugar and too little insulin in the body (hyperglycemia).
Signs and symptoms of diabetic coma develop more slowly than insulin shock and include drowsiness, confusion, deep and fast breathing, thirst, dehydration, fever, a change in the level of consciousness and a peculiar sweet or fruity smelling breath.
Distinguishing between the two types of diabetic emergencies can be difficult for the layperson so if the patient is conscious and you know they are diabetic (look for a Medic Alert Bracelet) ask them ‘did you eat today?’ and ‘did you take your medication today?’.
A person who has eaten but has not taken their medication may be in a diabetic coma and a person who has taken their medication but has not eaten may be in insulin shock.
As always, assess the scene for hazards, activate EMS, make sure the patient has an open airway and check for breathing and circulation. Don your barriers (gloves) and have a ventilation barrier handy.
Insulin shock is a true emergency and requires prompt action. A patient in insulin shock requires sugar….quickly! If the patient is conscious give them sugar in any form (some diabetics carry packets of glucose gel for these types of emergencies but candy, fruit juice or a soft drink will also work).
If the patient is in a diabetic coma assist them in taking their medication if possible. If you are unable to distinguish between insulin shock and a diabetic coma, give the patient sugar.
This will not make a diabetic coma worse but will greatly improve the condition of a patient in insulin shock.
Monitor the ABCD’s of the patient’s lifeline until EMS arrives.
To prevent diabetes maintain a healthy and well balanced diet, watch your weight and get plenty of exercise. Have a regular yearly physical, especially if there is a history of diabetes in your family, and see your doctor if you are concerned that you may be at risk.
This weekly column is only an introduction to emergency care skills and is designed to increase interest in First-Aid/CPR training. For information on courses please contact the Red Cross, a medical professional, or a local dive shop.