What is the treatment for a casualty with diabetes who is sweating trembling and confused?
Chapter 9. Blood Glucose Monitoring Show The overlapping symptoms of hypo- and hyperglycemia (e.g., hunger, sweating, trembling, confusion, irritability, dizziness, blurred vision) make the two conditions difficult to distinguish from one another (Paradalis, 2005). Since the treatment is different for each condition, it is critical to test the patient’s blood glucose when symptoms occur. The risk factors that may have led to the condition, and the recent medical history of the patient also help to determine the cause of symptoms. HypoglycemiaHypoglycemia is a condition occurring in diabetic patients with a blood glucose of less than 4 mmol/L. If glucose continues to remain low and is not rectified through treatment, a change in the patient’s mental status will result. Patients with hypoglycemia become confused and experience headache. Left untreated, they will progress into semi-consciousness and unconsciousness, leading rapidly to brain damage. Seizures may also occur. Common initial symptoms of hypoglycemia include:
These symptoms will progress to mood or behaviour changes, vision changes, slurred speech, and unsteady gait if the hypoglycemia is not properly managed. The hospitalized patient with type 1 or type 2 diabetes is at an increased risk for developing hypoglycemia. Potential causes of hypoglycemia in a hospitalized diabetic patient include:
Hypoglycemia is a medical emergency that must be treated immediately. An initial blood glucose reading may confirm suspicion of hypoglycemia. If you suspect that your patient is hypoglycemic, obtain a blood glucose level through skin puncture. A 15 g oral dose of glucose should be given to produce an increase in blood glucose of approximately 2.1 mmol/L in 20 minutes (Canadian Diabetes Association, 2013). Table 9.2 outlines an example of a protocol that may be used in the treatment of hypoglycemia. Table 9.2 Hypoglycemia Treatment
HyperglycemiaHyperglycemia occurs when blood glucose values are greater than 7 mmol/L in a fasting state or greater than 10 mmol/L two hours after eating a meal (Pardalis, 2005). Hyperglycemia is a serious complication of diabetes that can result from eating too much food or simple sugar; insufficient insulin dosages; infection, illness, or surgery; and emotional stress. Surgical patients are particularly at risk for developing hyperglycemia due to the surgical stress response (Dagogo-Jack & Alberti, 2002; Mertin, Sawatzky, Diehl-Jones, & Lee, 2007). Classic symptoms of hyperglycemia include the three Ps: polydipsia, polyuria, and polyphagia. The common symptoms of hyperglycemia are:
Other symptoms include glycosuria, nausea and vomiting, abdominal cramps, and progression to diabetic ketoacidosis (DKA). Potential causes of hyperglycemia in a hospitalized patient include:
Note that testing blood glucose levels too soon after eating will result in higher blood glucose readings. Blood glucose levels should be taken one to two hours after eating. If hyperglycemia is not treated, the patient is at risk for developing DKA. This is a life-threatening condition in which the body produces acids, called ketones, as a result of breaking down fat for energy. DKA occurs when insulin is extremely low and blood sugar is extremely high. DKA presents clinically with symptoms of hyperglycemia as above, Kussmaul respiration (deep, rapid, and laboured breathing that is the result of the body attempting to blow off excess carbon dioxide to compensate for the metabolic acidosis), acetone-odoured breath, nausea, vomiting, and abdominal pain (Canadian Diabetes Association, 2013). Patients in DKA also undergo osmotic diuresis. They pass large amounts of urine because of the high solute concentration of the blood and the body’s attempts to get rid of excess sugar. DKA is treated with the administration of fluids and electrolytes such as sodium, potassium, and chloride, as well as insulin. Be alert for vomiting and monitor cardiac rhythm. Untreated DKA can be fatal. Patients with hyperglycemia may also exhibit a non-ketotic hyperosmolar state, also known as hyperglycemic hyperosmolar syndrome (HHS). This is a serious diabetic emergency that carries a mortality rate of 10% to 50%. Hyperosmolarity is a condition in which the blood has a high sodium and glucose concentration, causing water to move out of the cells into the bloodstream. Further information on the treatment of DKA and HHS can be found on the Canadian Diabetes Association clinical guidelines website.
What is the treatment for a casualty with diabetes?You can give them sugary drinks such as cola, lemonade, fruit juice and isotonic sports drinks, and sweet foods such as jelly beans, chocolate and sugar cubes. The person may also be carrying glucose gel or tablets. Avoid giving them a diet drink, as it won't have any sugar in it and will not help them.
What are the first aid procedures for a diabetic episode?What to do. Help casualty into a comfortable position and reassure them.. Give sugar such as glucose tablets, jellybeans or a sweet drink (such as a soft drink or cordial). ... . If the person is able to follow simple commands and swallow safely, administer 15-20 grams glucose tablets (4 - 5 x 4 gram glucose tablets).. What is the management of a person suffering a diabetic episode and who is unconscious?If unconscious
It is common for these patients to be unconscious. If so, support the patient on their side and call 111 for an ambulance. In this situation, DO NOT give the patient anything to eat or drink.
What is the emergency treatment for someone with hypoglycemia?Glucagon—a hormone that raises blood glucose levels—is used to treat severe hypoglycemia. Glucose is taken as a spray into the nose or an injection administered under the skin. If you use insulin or a sulfonylurea to manage your diabetes, it's a good idea to keep a glucagon kit with you in case of emergencies.
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