First and foremost, let me be clear. The title is not implying that people who are diabetic appear to have, in some way shape or form a regularly altered mental status. We do want to point out that because of a diabetic incident, the common presentation that people see includes an altered mental state. This can include non-responsiveness, confusion, slurred speech and more. Unfortunately, these conditions can and have often been confused with drug overdoses and seizures, so instead of receiving glucose or OJ, the person may receive an entire box of Narcan as the first responder struggles to understand why the doses aren’t working (paramedics unfortunately see this often while they are waiting for officers to clear and make a scene safe). Therefore education is key, so lets just jump into it.
What is Diabetes?
Diabetes is a disease where blood cells cannot accept or process the sugar that enters our bodies (and is needed for life) without the presence of insulin. Diabetes typically comes in two main types and has two conditions.
Type-1 diabetes is often referred to as “juvenile diabetes” and occurs when a person has little or no ability to create insulin to help regulate the blood sugar levels in their body. Type 1 diabetics typically find themselves to be hyperglycemic, but especially when they are first diagnosed or when switching insulin types or diets, can find themselves to be hypoglycemic as well. These people are insulin dependent and must frequently monitor their sugar levels. In today’s day in age, people who are Type-1 diabetic typically have implanted monitors and automated insulin pumps that allow them to lead mostly normal lives.
Type-2 diabetics are non-insulin dependent and occurs in people who produce too little insulin or the insulin that is produced cannot be used properly by the body. This type of diabetes is primarily seen in older adults and is typically associated with poor diet, and is paired with secondary conditions such as high-blood pressure. Normally, this type of diabetes can be controlled with regulated diet and exercise and the use of oral medications.
Two main diabetic conditions
Regardless of the type of diabetic, people who experience a diabetic emergency are going to experience one of two conditions, Hyperglycemia or Hypoglycemia.
Hypoglycemia
The most common cause is Hypoglycemia meaning, low blood sugar. This condition is most often found in Type-2 diabetics and can be life threatening. Hypoglycemia can be caused in a variety of way but is typically found when a diabetic does any of the following:
- Takes too much insulin
- Reduces sugar intake by not eating
- Over exercises or over exerts themselves
- Has an illness which causes vomiting, resulting in a lack of sugar being consumed
Signs and Symptoms
Hypoglycemia can be a life threatening condition and can quickly cause permanent brain damage if sugar level aren’t replenished. Someone who is having a hypoglycemic episode may have the following symptoms:
- altered mental state
o irritability or moodiness
o confusion
o inability to concentrate
- Shakiness
- Dizziness
- Sweating
- Hunger
- Fast heartbeat
Treatment
The best and most rapid treatment for Hypoglycemia is to provide about 25 grams or ONE tube of Glucose; sometimes called Glutose or insta-glucose. Unless you have a history of diabetes or a diabetic family member this likely will not be available to you, but don’t worry. Other treatments include 15 to 20 grams of any fast acting carbohydrate (make sure fats and proteins are not on the label):
- Fruit juice
- Non-diet soda
- Honey
- Sugary candy
- Crackers
** Always follow-up with a re-check of blood-sugar levels after 15 minutes and look for levels above 70mg/dL.
Hyperglycemia
Just as Hypoglycemia means low blood sugar, Hyperglycemia means high blood sugar. This is usually caused by a decrease in insulin which leaves too much sugar in the blood stream as it cannot be absorbed by the blood cells without insulin. Hyperglycemia is a little more “sneaky” and can be caused by:
- Bodies inability to produce insulin
- Forgotten insulin injections
- Stress
- Infection
- Increased dietary intake
Signs and Symptoms
Hyperglycemia can also be a life-threatening condition, however the presentation is often slower and can be insidious. Long term hazards include skin conditions, nerve damage and blindness. Someone who is having a hyperglycemic episode will have a blood sugar level of 120-140 mg/dL and should have several of the following symptoms:
- Altered mental state
o Confusion
o Coma
o Inattentive/unable to focus
- Frequent urination
- Nausea and vomiting
- Persistent thirst
- Persistent hunger
- Fruity smelling breath (or breath that smells like finger nail polish remover due to ketoacidosis)
- Abdominal pain
Treatment
The best treatment for those with Hyperglycemia is to follow doctors orders.
Continue to exercise!
Physical activity can help to use up excess glucose in the bloodstream. However if you notice symptoms of ketoacidosis (sweet or alcohol smelling breath), stop all exercise as exercise will break down fats and could ramp up your ketoacidosis.
Monitor your diet!
Eating and snacking less and focusing on low sugar foods can help keep your blood sugar levels down. As always follow the advice and guidance of your dietician or doctor.
Be open to change!
You may find that you need to frequently change your medication type or the time in which you need to take your medication. Use timers and alarms to help keep you on track and make sure to update any emergency information.
Still have some doubts?
When in doubt GIVE THE PERSON THE SUGAR. If you are unsure if the person is overdosing or having a diabetic episode, give them the Narcan and the Sugar.
For those who are hypoglycemic the sugar will absolutely save their life and you will see a rapid improvement in their condition. For those who are hyperglycemic, their body already has a low insulin value, therefore more sugar in the bloodstream will not have an immediate negative effect, giving you more time to get to a hospital for diagnosis and treatment.
If you found this article to be helpful or informative, leave us a like on Facebook (@EMP2C), check out the rest of our blogs here on our website, share our articles with your friends and family and consider taking a first aid course with us. We aren’t your momma’s First Aid training provider. We always cover the required content, and then strive to give you that little bit extra. Check us out today at www.emp2c.com/firstaidtraining
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