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Past medical history. Do you remember what the history was on that guy? Speaker 2: I, Oh no. Speaker 1: Did he have any allergies? Speaker 2: I, I'm not, I don't know. I don't. Speaker 1: What are you doing? You haven't done any of this. Speaker 2: I'm alright. Speaker 1: Man, we gotta go. We gotta clear. Speaker 2: It's okay. Speaker 1: C'mon buddy, we gotta get going. Speaker 2: Yeah Speaker 1: What was, you picked up his list of medications, right? Speaker 2: Yeah, yeah. Speaker 1: Jodie Speaker 2: Huh? Speaker 1: Are you feeling okay? I thought you were just kidding around. Now you're acting like your sugar's low. Speaker 2: I, I don't, yeah I'm okay. Speaker 1: What are you drinking? This is diet pop. Hey listen, I think you should, I think your sugar's low. You're acting like your sugar's low. Have you checked your blood sugar? Speaker 2: No, I no. Speaker 1: Here listen, I want you to take some sips of this. Take some sips. C'mon. Speaker 2: Alright. Speaker 1: Just start sipping that. Because if this doesn't get any better we're going to get you some help. Did you have lunch? Speaker 2: No. Speaker 1: Here, drinks some more then. Drink some more. Speaker 2: Alright, alright. Speaker 1: Now, lets talk about emergencies that can occur due to blood sugar problems. So, some of the first signs and symptoms of a person who might be experiencing a sugar issue is if they become confused. They might start messing with something. They're kind of doing random acts that are not coordinated. Or they start saying things that really don't quite add up. And that will progressively get worse, both with high blood sugar and low blood sugar. But I think there's some distinctions we should make. When a person suffering from high blood sugar, regardless of their diabetic condition, high blood sugar usually comes on slower over time. Now, the side effects are less drastic but they really end up kind of being the same. Confused, headache, not feeling well, and eventually they will go unresponsive and end up dying if they're not treated appropriately. Low blood sugar on the other hand actually occurs much more quickly and the onset could be from minutes to, you know, 10, 15, 22, maybe less than an hour, where this person really begins to lose their blood sugar and they really get confused and do things randomly much more quickly. Now the treatments in our situation are going to be the same, but the condition is different for the long term definitive treatment. So, keep that in mind as we go through this. Now, what would you know about a high blood sugar event vs a low blood sugar event. The fact that they are basically having these symptoms gradually come on. Their body is trying to burn off the blood sugar any way it can. That could be through urination, it could be through hyperventilation and what happens when they hyperventilate is they're actually blowing off ketones. Ketoacidosis is the by-product of unused sugar or improperly used sugar that's becoming a bit toxic in the body. And the body knows it's gotta get rid of this. And again, if it can't urinate it out, it's going to even try to respirate it out. So, what we might smell in a high blood sugar is that fruity acetone type of smell, that almost like cheap wine kind of smell on the breath, but they haven't been drinking wine, you know, and they haven't been eating fruit. And so that might be a giveaway that they may be fighting high blood sugar instead of low blood sugar. However, let's not get hung up on whether it's high or low. If they begin acting confused, if they begin to kind of show some of those signs and symptoms that they are having a blood sugar issue, the way that we treat that is to rule it out with sugar. Now, it can be done through over the counter, where you just have soda randomly available or it can be done through other particular products that are designed to be used for diabetic emergencies, specifically low blood sugar. Now, these can only be used if the person can actually swallow safely. If they're to a point in their sugar that, where they can no longer control their swallowing reflex without choking, it's too late. We need to activate EMS, call 911 and get help on the way so we can get them the sugar that they need through IV or through glucagon treatment through an inter-muscular injection. But as long as this person was so able to kind of follow commands, they weren't getting overly aggressive or agitated or combative we could possibly just encourage them to start drinking some soda or something with some glucose in it to rule out the sugar issue. If it's low blood sugar, this should help within about 10-15 minutes. If it does not help after 15 minutes it's an EMS call. We might have something else going on. But, as long as they're trying, as long as it's improving and not digressing we're heading in the right direction. But some of these other products I like a little better than relying on soda or a candy bar because they're designed to absorb quickly and they're designed to be more stable when they're in their packages. What do I mean by that, well if I was going to rely on a gel or a liquid, what happens if it's in my car and it gets freezing cold outside and the substance turns into ice. Well, that's not going to work very well. So, you got these glucose tabs that are really stable and it's going to be very difficult for them to freeze to a point where a patient cannot chew them up and absorb that much-needed glucose. One of the things to think about though is, is the soda diet or is it regular? You know, time and time again I've kind of responded to the places where they said "yeah, I was giving them pop or soda and it wasn't helping. And I look at the bottle and it turns out to be a non-sugar product. That would explain why it's not affecting the diabetic or the low blood sugar event. There's also the concern that we're dealing with fibrous longer absorption rate foods which are great for sugar problems that are slowly creeping in and you know it and so you eat a snack to try to stabilize the dip but not for emergency rescue of a low blood sugar event. This is something we need to have that it's going to absorb quickly. Keep an eye on the actual dosage. Remember, most of these people that have sugar problems, they have talked to their physician and the physician has told them what kind of grams they should be trying to absorb when they're running into a situation. These are 4 gram per tablet glucose tabs. So if they were supposed to get 20 grams of glucose, we would need to give them 5 tablets, not just 1. So keep that in mind when you look at the different grams of sugar per serving or per dose when you have these available for you. This container is 70 grams of sugar just in this one bottle. Obviously a third of the bottle is going to be plenty of sugar to try to bring that blood sugar up, but because it may be made out of high fructose corn syrup, the burn rate of those sugars is going to be much more rapid than a longer-acting dextrose. They're all going to burn out though. So after they experience that diabetic emergency it's important that if it's the first time, you follow up with emergency medical services and get them the definitive care that they need and if they're a known diabetic and they know how to keep it going or they can explain why they had this sugar event then get them back on the plan so that they don't have it again. And maybe they took their insulin but they didn't eat lunch, or whatever the case may be. Or, it may be time to check in with their physician, let them know it happened, as they might be fighting an infection or something may have changed with their diabetes. Either way, contacting emergency services is always a great backup plan and buys us time for their sake and getting them back on track so they can get their diabetes under control.
In this lesson, you'll learn how to treat a patient 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, a patient 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.
Pro Tip #1: Even though the signs of high blood sugar are the same as those for low blood sugar, in patients suffering from high blood sugar, those symptoms will come on much more slowly and will likely be less intense.
How to Treat a Blood Sugar Event
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim.
"Hi, my name's _____. I'm a paramedic. I'm going to help you."
Pro Tip #2: When a patient has high blood sugar, the body will try to rid itself of it through urination, and failing that, through hyperventilation. Which is why, in patients with high blood sugar, you'll often notice a hint of fruit or cheap wine on their breath. The reason for this is called ketoacidosis – a byproduct of unused sugars in the body that become toxic.
Pro Tip #3: If a patient is showing signs of a blood sugar issue, rule it out using sugar – either over-the-counter products like soda or professional glucose products specifically for diabetic events.
Follow the pro tip above as long as the patient is coherent enough to follow commands and isn't getting agitated or aggressive. Then begin encouraging the consumption of sugar or glucose.
Warning: A patient 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.
If the patient did have low blood sugar, you should notice improvements in 10 to 15 minutes. If the symptoms aren't improving after 15 minutes, there could be something else going on; call 911 and activate EMS.
Professional glucose products like tabs and gels are your best bet, as they're designed for quick absorption. They're also encased in more stable packaging, meaning they can withstand freezing temperatures and other environmental threats.
If you don't have any glucose products available, a full-sugar soda is your best option. Candy bars aren't a bad option either. However, more fibrous snacks will take too long to be absorbed by the body.
Pro Tip #4: Most patients with sugar problems will know the dosage of sugar or glucose they need in emergencies like this. Read labels on the packaging and multiply or divide as needed to get the proper dosage.
Keep in mind that high fructose corn syrup burns much more quickly compared to the longer-acting dextrose you'll find in many glucose products.
If this was the patient's first sugar event, follow up with EMS to make sure they get the help they need moving forward.
If this wasn't the patient's first sugar event, and they can explain what likely caused it, help them get back on their plan to avoid it happening again. And encourage them to check-in with their physician to make sure everything is all right.
A Word About Diabetic Emergencies
Diabetes mellitus is one of the leading causes of death and disability in the U.S. In 2016, 29 million Americans had diabetes, while another 86 million had prediabetes – a condition that increases your risk for developing type 2 diabetes and other chronic diseases like kidney disease, heart disease, gum disease, stroke, and amputations.
The Two Types of Diabetes
Type 1 Diabetes – Also known as juvenile diabetes or insulin-dependent diabetes, this condition results in a body that produces little to no insulin. Which is why most people who have type 1 diabetes inject themselves with insulin daily.
Type 2 Diabetes – More common than type 1 diabetes, type 2 is characterized by a body that produces insulin, but either the cells can't use it effectively or not enough is being produced. People with type 2 diabetes can often improve their symptoms and regulate their blood glucose levels with dietary changes and sometimes medications.
High Blood Glucose
High blood glucose, or hyperglycemia, is when the body's insulin level is too low, and the sugar level is too high. However, the body cannot transport that sugar into the cells without insulin. Which results in a body that's about to have an energy crisis.
The body then attempts to meet its need for energy by using other stored food and energy sources, such as fats. However, converting fat to energy is less efficient, produces waste products, and increases the acidity level in the blood, causing a condition known as diabetic ketoacidosis (DKA), which could ultimately result in a diabetic coma.
Low Blood Glucose
The exact inverse of the above – Low blood glucose, or hypoglycemia, occurs when the body's insulin level is too high, and the sugar level is too low.
This can happen for a number of reasons, including when the patient:
- Takes too much insulin
- Fails to eat adequately
- Over-exercises and burns off sugar faster than normal
- Experiences great emotional stress
Regardless of whether you're dealing with a patient who has type 1 diabetes or type 2 diabetes, the signs and symptoms are the same:
- Dizziness, drowsiness, or confusion
- Irregular breathing
- Abnormally weak or rapid pulse
- Feeling and looking ill
- Abnormal skin characteristics