DIABETES

 

DIABETES: a chronic, lifelong medical condition which occurs when the pancreas fails to produce sufficient insulin or the body develops a resistance to the action of its own insulin. (ARC 2017)

Type 1: is an auto-immune disease that often develops in childhood, and requires lifelong treatment with insulin.
Type 2: is more commonly recognised in adulthood, and requires a combination of diet, exercise, medication and sometimes insulin.

Symptoms of HYPOglyceamia include: sweating, pallor, rapid pulse, shaking, trembling or weakness, hunger, dizziness, headache, mood changes, confusion, inability to concentrate, slurred speech, unresponsive, seizure

Symptoms of HYPERglyceamia include: excessive thirst, frequent urination, dry skin/mouth, rapid pulse, nausea and vomiting, rapid breathing fruity sweet smell of acetone on the breath, confusion/ deteriorating level of consciousness

Treatment: HYPOglycaemia

  1. Stop any exercise- rest and reassure

  2. Check blood sugar level if monitor available

  3. If the patient is able to follow simple commands and swallow, give simple

    carbohydrates (eg: jelly beans, sugary drinks, etc)

  4. If patient is unresponsive, place in recovery position and rub simple

    carbohydrates into buccal lining (pre-chewed or gels)

  5. Monitor for improvement – symptoms resolution expected within 15 min

  6. Pre-empt onset of shock- treat for environment

  7. Follow-up with complex carbohydrates (eg: sandwich, rice, etc)

Special Note: Never give Insulin to a Diabetic Patient as a First responder

Evacuation:

HYPO: Consider: For known diabetics, monitor resolved hypo for 24hrs (provided patient does not have compounding issues- eg: trauma). Consider evac for relapse or first-time presentations Rapid: If patient shows no signs of improvement, relapses, has altered level of consciousness (including persistent behavioural changes) or becomes unresponsive

HYPER: Consider: All T2/NIDDM patients experiencing hyper in a wilderness setting; monitor T1/IDDM regularly and consult/manage according to diabetes action plan Rapid: Altered level of consciousness, unresponsive

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