Diabetes is a disease caused by inadequate production of insulin. Insulin shock results from too much insulin causing low blood sugar, while diabetic coma results from not enough insulin causing high blood sugar. The goal in managing diabetes is to maintain target blood glucose levels. Signs of insulin shock include rapid pulse and confusion, while signs of diabetic coma include rapid breathing and dehydrated skin. Treatment involves monitoring vital signs, giving oral glucose if conscious, and transporting to advanced care. Diabetes is managed through balancing food, medication, exercise and monitoring blood glucose levels.
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Diabetes
Diabetes is a disease caused by the
inadequate production of insulin
Insulin Shock (hypoglycemia at it’s worse
case) results from too much insulin in the
blood, causing low sugar levels for the brain
and nervous systems
Diabetic Coma (hyperglycemia at it's worse
case) results from an inadequate insulin
supply that leads to unconsciousness, coma
and death if not treated
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Diabetes is Managed,
But it Does Not Go Away.
GOAL:
To maintain target
blood glucose
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Diabetic Coma (Hyperglycemia)
Hyperglycemia is a lack of insulin, this
causes too much sugar in the blood and
not enough in the cells
Causes:
Too much food
Not taken insulin
Insulin facilitates the transport of sugar
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Diabetic Coma (Hyperglycemia)
Signs and Symptoms…
Rapid deep breathing
Rapid weak pulse
Decreased level of consciousness
Dehydrated (dry), warm skin
Sweet or fruity, (acetone) odor on breath
Dry mouth and intense thirst
Increasing restlessness, confusion
This onset of this condition is gradual over
a period of days
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Diabetic Coma (Hyperglycemia)
Care for the Patient…
Keep at rest in position of comfort
Obtain a good history (meals, insulin)
High flow O2
Reassurance
If unsure whether insulin shock or diabetic coma, give
glucogel or instagel if patient has a patent airway
Monitor vital signs
Transport the patient to advanced medical care
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Insulin Shock (Hypoglycemia)
There is too much insulin, causing a lack
of sugar in the blood.
Some causes are:
Not enough food
Too much insulin
Excessive exercise
Insulin facilitates the transport of sugar
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Insulin Shock (Hypoglycemia)
Signs and Symptoms…
Normal breathing
Rapid, full pulse
Decreased or altered level of consciousness
Pale, moist skin (sweaty at times)
Dizziness, headache
Fainting
Seizures
Disorientation
Coma
This onset of this condition is sudden, can occur
within minutes
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Insulin Shock (Hypoglycemia)
Care for Patient
Keep at rest – position of comfort
S-A-M-P-L-E history (Insulin, meals, etc.)
High flow O2
Monitor vital signs
Nothing by mouth, unless their alert
If unsure whether insulin shock or diabetic
coma, give the patient instagel or glucogel
Transport patient to advanced care
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Diabetes
Gestational diabetes
Some women may develop gestational
diabetes during pregnancy. These
women are non-symptomatic before the
pregnancy. Generally, glucose levels
will return to normal after the pregnancy,
although there is a higher risk of
developing diabetes later in life
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Diabetes
There are many risk factors for
diabetes, including:
A parent, brother, or sister with diabetes
obesity
Age greater than 45 years
Some ethnic groups (particularly African-
Americans, and First Nation)
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Diabetes
Gestational diabetes or delivering a baby
weighing more than 9 pounds
High blood pressure
High blood levels of triglycerides (a type
of fat molecule)
High blood cholesterol level
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Diabetes
Measuring Glucose Level
Blood Glucose Level (BGL) is measured
in millimoles per litre (mmol/l), and a
normal BGL ranges from 4 mmol/l to 7
mmol/l. Hypoglycemia is most often
defined as a BGL of less than 4 mmol/l,
whereas hyperglycemia is defined as a
BGL of greater than 7 mmol/l.
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Diabetes
To accurately check someone’s BGL,
use a device called a glucometer. Use
this reading, along with a patient’s
history and any signs and symptoms
found during assessment, to determine
whether to treat the situation as a
diabetic emergency.
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Diabetes
How to use the Glucometer
Prepare the lancet and lancet device
Let the patient’s arm hang to the side if
possible
Remove a new test strip from the vial
and insert it into the device
Match the code number on the screen to
that of the test strip vial
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Diabetes
Cleanse the finger and force blood to the
finger by squeezing the finger
Prick the side of the finger and gently squeeze
out a drop of blood
Drop the blood onto the test strip in the
appropriate place, cover lancet site with a
Band-Aid
Record the BGL reading
Remove the test strip and dispose into a
biohazard bag
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QUESTIONS
5148
1: Which of the following is a common
sign or symptom of a patient
experiencing a diabetic emergency?
A: Slow pulse
B: Pale, clammy skin
C: Elevated blood pressure
D: Decreased respiratory rate
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QUESTIONS
2: Altered mental status that often
accompanies diabetic emergencies is often
mistaken for:
A: a migraine.
B: alcohol intoxication.
C: a severed spinal cord.
D: a swollen or deformed lower extremity.
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QUESTIONS
3: Diabetes is considered a disease of
balance because the patient must try to
balance:
A: food intake with glucose therapy.
B: medication with charcoal intake.
C: medication to stimulate the liver with fat
intake.
D: the need for glucose with the available
insulin supply.
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ANSWER
A: food intake with glucose therapy.
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QUESTIONS
4: Which of the following conditions can occur
if an unconscious patient is given oral
glucose?
A: Shock
B: Aspiration
C: Hypotension
D: Hyperglycemia
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QUESTIONS
6: The form of diabetes that develops as a
person ages is called:
A: type I diabetes.
B: type II diabetes.
C: type III diabetes.
D: adult sugar disorder.
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QUESTIONS
7: Which of the following will probably NOT
cause a diabetic emergency in a patient with a
history of diabetes controlled by medication?
A: Eating a regularly scheduled meal
B: Unusual exercise or fatigue
C: Overeating
D: Infection
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ANSWER
A: Eating a regularly scheduled meal
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QUESTIONS
8: Oral glucose should be placed:
A: on the tongue of a conscious patient.
B: on the tongue of an unconscious patient.
C: between the cheek and gum of a conscious
patient.
D: between the cheek and gum of an
unconscious patient.
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ANSWER
C: between the cheek and gum of a
conscious patient.
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QUESTIONS
9: The term "polyuria" can be defined as
frequent:
A: seizure activity.
B: bouts of depression.
C: Urinating excessively.
D: drinking to satisfy continuous thirst.
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QUESTIONS
10: What waste products are formed when fat
is used for energy?
A: Pancreatic acids
B: Glucose and carbon dioxide
C: Glucose and fatty acids
D: Ketones and fatty acids
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Whether we consider type 1 or type 2 diabetes, the goal of effective diabetes management is to control blood glucose levels by keeping them within a target range that is individually determined for each child. Optimal blood glucose control helps to promote normal growth and development and allows for optimal learning. It is also needed to prevent the immediate dangers of blood glucose levels that are either too high or too low. Research has shown that maintaining blood glucose levels within the target range can prevent or delay the long-term complications of diabetes such as heart attack, stroke, blindness, kidney failure, nerve disease, and amputations of the foot or leg.
When insulin is no longer made, it must be obtained from another source--insulin shots or an insulin pump. All people with type 1 diabetes must take insulin. People with type 2 diabetes use diet and exercise, and oral medications, and/or insulin to manage their disease. Neither insulin nor other medications, however, are cures for diabetes: they only help control the disease.
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Maintaining good blood glucose control is a constant juggling act, 24 hours a day, 7 days a week.
The key to optimal diabetes control is a careful balance or juggling of food, exercise, and insulin and/or oral medication.
As a general rule, insulin/oral medication and exercise/activity makes blood glucose levels go down.
Food makes blood glucose levels go up.
Several other factors, such as stress, illness or injury, also can affect blood glucose levels.