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[laughing] Speaker 2: Elizabeth, are you feeling okay? Speaker 3: I don't know. I don't feel very good. Speaker 2: I think we should go find some help. Speaker 1: Now let's take a closer look at diabetic emergencies. When we talk about diabetic emergencies, we could get really, really intricate about what causes it and is it insulin resistance and all that kind of stuff, but I think for the sake of this training, we're going to simplify it down to two major types of emergencies that can occur due to a diabetic emergency and that is this: high blood sugar and low blood sugar. Now, let's break those out a little bit. High blood sugar and low blood sugar, though they have the similar signs and symptoms, high blood sugar is different for a couple different reasons. High blood sugar can develop in hours to days, and when it develops, it's a little bit different in that it also shows some symptoms like a child needing to drink more often than normal. Maybe they're drinking more water, maybe they're drinking more pop, maybe they're just always thirsty. We call this polydipsia. Polydipsia is that insatiable thirst that they cannot quench. Now, when they have this symptom, it's usually accompanied with having to go to the bathroom a lot as well. That's another way that the body's trying to get rid of that excess sugar in their bloodstream and in their tissues and that's by going to the bathroom a lot. So another sign or symptom. Now, backing up just a little bit, let's say that you didn't know that the child was a diabetic. These are sometimes the first signs of juvenile diabetes is that we see the child drinking more than they usually do and going to the bathroom more than they usually do. Not that that's always for sure, but it's definitely a flag that should maybe bring us to the doctor and take a closer look. And now back on track with the high blood sugar. One of the last symptoms that's really bad and is usually at the tail end of a high blood sugar event is something we call ketoacidosis. Now ketones can be actually smelled on the breath of a high blood sugar patient. It's usually like cheap wine or a fruity overtone, and that can be an indicator that the person is suffering from high blood sugar. So what can we really do about high blood sugar out in the field? Not a whole lot. We can activate emergency medical services or get the person to an emergency room so that they can be definitively treated and get back on track. Now let's focus more on the one that you can do something about in the field, and that's low blood sugar. So, in a low blood sugar event, it's different from high blood sugar in that it can come on within seconds to minutes and it can surprise people. Whether they're a known diabetic or an unknown diabetic, the treatment should be about the same. So what is the goal of getting someone into a more stable position when they have a low blood sugar event and are showing those signs and symptoms of dizziness, lethargy, they might be confused, they might have slurred speech, they don't want to play anymore, they're grumpy? Getting them sugar. But there's different ways to get the sugar into their system faster than others, and I want to talk about that here in just a minute. There's lots of different food sources around that we can choose from but not all of them will get the sugar into the bloodstream as quickly as the ones I'm going to talk about next. If you look at some of these high-grain, high-fiber snacks that are common at a picnic table, they're good and in some cases they're good for you, but they're not necessarily good to treat a diabetic emergency. Meat sticks, granola bars, and chips are probably not our first choice to getting their blood sugar up. Though they can over a longer period of time, that's not our emergency treatment. I want to take a look at some that are a little bit faster and are more preferable under the treatment guidelines. Orange juice is a fantastic way to get their sugar up. In this one small bottle, there's literally 44 grams of sugar. They shouldn't have to drink much more than a third to a half the full container to give them more than enough sugar to get their blood sugar level back to where it should be, get them thinking more clearly, and then buy us some time for EMS to arrive or to get them to their doctor or to an emergency room. A couple other options that you could use are over-the-counter, you could get them at most drug stores, probably some grocery stores, and that's glucose in the form of tablets, in the form of liquid, and in the form of a gel. The reason I like these is that they're closed, sealed bottles, and they're really stored in a more stable state. You got orange juice here, but in most cases it needs to stay refrigerated, and it has an expiration date that probably is a little faster than some of these other options. Now, I like these because, depending on the child, they may have something that they like more than the other. Maybe they like chewing candy so you would opt for the tabs, but keep in mind that you should know, and here's a little Roy hint, you might want to write on this the number that you should be using, your doctor would probably tell you this, because in this case, every tablet's only 4 grams of sugar. So you might think it's one tablet per treatment, but in actuality, to equal the half of this bottle, you need five tablets. It's four grams per tablet, you would like five to equal the half bottle of orange juice. The liquid here comes in 22 grams by itself, and the gel is another 18 grams. So understanding how much sugar or glucose is actually in these tabs is important. Remember that these have been designed to absorb quickly into the digestive tract of the patient, and so they may work a little faster than a candy or a regular soda. Now, one point of interest here where we come to drinking over-the-counter beverages is be careful of diet things. Diet sodas tend not to have any sweetener that's sugar-based or glucose-based at all. So we've actually, I've had patients who they've gotten treated with diet pop and their family didn't understand why it didn't bring their loved one around. Well, it was because there wasn't any sugar in the soda. So make note of that, no diet sodas, no diet candies, they won't work in this situation. The second point is that it can take up to fifteen minutes to actually absorb the amount of sugar or glucose needed to reverse the effects of a hypoglycemic event. So remember, if this person is a known diabetic and a doctor is giving you a prescription of what to do if they have a low blood sugar event, it may be that after you give them the appropriate amount of sugar or glucose, that you wait five, ten, fifteen minutes to see if it reverses the hypoglycemic symptoms before you activate emergency medical services. However, if this is your first hypoglycemic event, it's going to be important to call 9-1-1 right away. The other piece here to note, in closing, is that when we have these different packages, they almost all come with a seal. As I was preparing these for this instructional, I was picking at the actual seal, and I realized that some of them are very difficult to undo. Now, keep in mind, some of the effects of the decreased level of consciousness and confusion is only going to make opening these that much more difficult. So if you can take the outer seal off, it's just a protective device so that you know it has never been opened, get it prepared so that you can open it more easily and consume its contents when it's an emergency and it counts. So, I hope this helps, wait for EMS, watch the patient to develop any life-threatening problems, and if they do, we'll know what to do, we can move on to our next level of treatment.
In this lesson, you'll learn how to help a person with a blood sugar emergency. Some things to keep in mind about blood sugar problems:
- Signs and symptoms are the same for low blood sugar and high blood sugar
- Blood sugar issues will get worse without treatment
- Without treatment, the person could become unresponsive and die
The three most common signs and symptoms of someone experiencing a blood sugar issue are:
- Confusion
- Coordination issues
- Talking nonsense
A person with a blood sugar issue might also randomly fidget with something and appear quite out of it.
There are two major types of diabetic emergencies – high blood sugar and low blood sugar. High blood sugar is different than low blood sugar for a few important reasons.
- The signs and symptoms of high blood sugar can take hours or days to appear.
- It usually involves noticeable increases in thirst and urination, as the body tries to rid itself of excess sugar. (Incidentally, these are often the first signs of diabetes.)
- There's very little treatment that can be provided outside of a healthcare environment. In high blood sugar emergencies, call 911 or get the person to an emergency room for treatment.
Pro Tip #1: The latter stages of a high blood sugar emergency will involve something called ketoacidosis, which produces a tell-tale sign of a fruitiness or cheap wine smell on the breath.
While you cannot do anything about high blood sugar, you can provide help to those suffering from low blood sugar emergencies.
Warning: Low blood sugar emergencies can easily catch people by surprise, as symptoms can appear in seconds or minutes.
Some common signs and symptoms of low blood sugar include:
- Dizziness
- Lethargy
- Confusion
- Slurred speech
- Agitation
How to Provide Care
Treatment for low blood sugar can be summed up with one word: Sugar.
However, some delivery methods are faster than others. And some sugars aren't really sugars at all. Let's explain.
Sugary food sources are abundantly available, which makes them good options in a diabetic emergency. However, you'll want to steer clear of the carbs, particularly grains and fibers, as these are slow digesting and will hinder the quick fix you're looking for.
Instead, focus on candy, or better yet, drinks. Sodas and especially orange juice are great food options. Just make sure the ingredients in your “medicine” includes sugar and not a sugar substitute. So, no diet sodas for sure.
A Better Option – Glucose Tabs, Liquid, Gel
This option is especially key for known diabetics or friends and family members of known diabetics.
Glucose products have been specially designed to be absorbed quickly. These products are more beneficial for reasons beyond how fast they work though, including:
- Long shelf life
- Stable in extreme heat and cold
- Small, easy to carry in a purse, backpack, etc.
While glucose products are a great option for all of these reasons, they can be quite difficult to open. They naturally come sealed to avoid tampering, and while not particularly difficult to open when lucid and sober, when you're confused and dizzy and in the grips of a diabetic emergency, it could be problematic.
Not to worry. Simply remove the seal in advance of any emergencies, and you may just shave some precious time off the delivery of treatment.
Pro Tip #2: Known diabetics should know what their glucose dose is, just like any other type of medicine. This is something a physician can address. Knowing how much glucose you need in a diabetic emergency may be invaluable, and a much better option than guessing.
A Few Common Questions About Diabetic Emergencies
How long does it take for glucose products to work?
It can take up to 15 minutes to feel the effects of consuming sugar or glucose after a hypoglycemic event. Known diabetics will hopefully know what their dose is and how long to wait after the first dose before taking another.
If the person having the diabetic emergency isn't a known diabetic, you'll have to guess when it comes to dosing. If symptoms aren't improving after a couple of doses (for glucose products) or a full 16-ounce bottle of soda or orange juice, there could be something else going on; call 911 and activate EMS if you haven't already done so.
What if the person having the diabetic emergency is having trouble swallowing or keeping food and fluids down?
A person can only consume a glucose or sugar product if they are able to swallow safely. If their sugar event has escalated to the point where they cannot control their swallow reflex, it's too late. Sugar will need to be administered through an IV or by intermuscular injection.
Call 911 immediately and activate EMS if this is the situation.
In what other situations should I call 911?
Any situation beyond the scope of your care should involve a 911 call. But as it pertains to diabetic emergencies, call 911 if the victim:
- Isn't breathing normally
- Loses consciousness
- Loses a pulse
- Goes into shock
- This is your first hypoglycemic event
You may have gone through a diabetic emergency before, either involving yourself or someone else. But if this is your first diabetic emergency, be on the safe side (whether you're the victim or the rescuer) and call 911.