Diabetes can cause two dangerous emergencies: hypoglycemia and hyperglycemia. These conditions occur when blood sugar levels drop too low or rise too high, respectively. Both can be life-threatening if not treated promptly.

Recognizing the signs of diabetic emergencies is crucial for first responders. Hypoglycemia requires fast-acting carbs, while hyperglycemia may need medical intervention. Understanding these conditions helps provide effective care for diabetic patients in crisis.

Hypoglycemia

Causes and Symptoms

• Hypoglycemia occurs when blood glucose levels drop too low, typically below 70 mg/dL
• Can be caused by taking too much insulin, skipping meals, or engaging in excessive physical activity
• Symptoms include shakiness, dizziness, confusion, sweating, and rapid heartbeat
• If left untreated, hypoglycemia can lead to seizures, unconsciousness, and even death

Treatment

• Treat conscious patients with 15-20 grams of fast-acting carbohydrates such as glucose tablets, fruit juice, or regular soda
• Recheck blood glucose levels using a blood glucose meter 15 minutes after treatment and repeat if levels remain low
• For unconscious patients or those unable to swallow, administer glucagon intramuscularly or intravenously
  • Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream
  • Glucagon kits are available by prescription for emergency use

Hyperglycemia and Diabetic Emergencies

Hyperglycemia

• Hyperglycemia is a condition characterized by high blood glucose levels, typically above 180-200 mg/dL
• Can be caused by insufficient insulin, infection, stress, or consuming too many carbohydrates
• Symptoms develop gradually and may include increased thirst, frequent urination, blurred vision, and fatigue
• If left untreated, hyperglycemia can progress to more serious complications such as diabetic ketoacidosis or diabetic coma

Diabetic Ketoacidosis (DKA)

• DKA occurs when the body produces high levels of blood acids called ketones due to insufficient insulin
• Ketones build up in the blood and urine, leading to a chemical imbalance in the body
• Symptoms include nausea, vomiting, abdominal pain, rapid breathing, fruity-smelling breath, and confusion
• DKA is a life-threatening emergency that requires immediate medical attention and treatment with insulin and intravenous fluids

Treatment

• For mild to moderate hyperglycemia, patients may be treated with increased insulin doses and oral hydration
• Severe hyperglycemia or DKA requires hospitalization for intravenous insulin therapy, fluid replacement, and electrolyte management
• Monitor blood glucose levels closely and adjust insulin doses as needed to gradually lower blood glucose to target range

Diabetes Mellitus Overview

Types and Causes

• Diabetes mellitus is a chronic condition characterized by high blood glucose levels due to insufficient insulin production or insulin resistance
• Type 1 diabetes is an autoimmune disorder in which the body's immune system attacks and destroys the insulin-producing cells in the pancreas
• Type 2 diabetes occurs when the body becomes resistant to insulin or the pancreas doesn't produce enough insulin
• Gestational diabetes develops during pregnancy due to hormonal changes that affect insulin sensitivity

Management

• Treatment goals for diabetes include maintaining blood glucose levels within a target range, typically 80-130 mg/dL before meals and less than 180 mg/dL two hours after meals
• Management strategies include regular blood glucose monitoring, healthy eating, physical activity, and medication (insulin or oral diabetes medications)
• Patients with type 1 diabetes require lifelong insulin therapy through injections or an insulin pump
• Patients with type 2 diabetes may be managed with lifestyle changes, oral medications, and/or insulin therapy
• Regular check-ups with a healthcare provider are important to monitor diabetes control and screen for complications such as nerve damage, kidney disease, and eye problems