Diabetes

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Diabetes

  1. 1. Diabetes <ul><ul><li>Temple College </li></ul></ul><ul><ul><li>EMS Professions </li></ul></ul>
  2. 2. Glucose <ul><li>Required as fuel for cellular metabolism </li></ul><ul><li>Brain’s need for glucose parallels its demand for oxygen </li></ul>
  3. 3. Insulin <ul><li>Hormone </li></ul><ul><li>Produced by Islets of Langerhans in pancreas </li></ul><ul><li>Required for sugar to enter most cells </li></ul><ul><li>Brain does not require insulin to use sugar </li></ul>
  4. 4. Pancreas <ul><li>Located in retroperitoneal space </li></ul><ul><li>Produces, releases </li></ul><ul><ul><li>Digestive enzymes into duodenum </li></ul></ul><ul><ul><li>Insulin, glucagon into blood </li></ul></ul>
  5. 5. Islets of Langerhans <ul><li>Alpha cells </li></ul><ul><ul><li>Glucagon </li></ul></ul><ul><ul><li>Raises blood sugar </li></ul></ul><ul><li>Beta cells </li></ul><ul><ul><li>Insulin </li></ul></ul><ul><ul><li>Lowers blood sugar </li></ul></ul>
  6. 6. Diabetes Mellitus Metabolic disease Characterized by inadequate, absent insulin production
  7. 7. Type I Diabetes <ul><li>No insulin production </li></ul><ul><li>Takes insulin injections </li></ul>
  8. 8. Type II Diabetes <ul><li>Inadequate insulin production </li></ul><ul><li>Increased tissue resistance to insulin effects </li></ul><ul><li>Controlled with </li></ul><ul><ul><li>Diet </li></ul></ul><ul><ul><li>Oral medications: </li></ul></ul><ul><ul><ul><li>Diabeta, Diabinese, Dymelor, Glucotrol, Micronase, Orinase, Tolinase, Glucophage </li></ul></ul></ul><ul><ul><li>Insulin injections as disease progresses </li></ul></ul>
  9. 9. Problems in Diabetes
  10. 10. Blood Sugar Imbalance <ul><li>Hyperglycemia </li></ul><ul><ul><li>Diabetic ketoacidosis (DKA) </li></ul></ul><ul><ul><li>Hyperosmolar coma </li></ul></ul><ul><li>Hypoglycemia </li></ul>
  11. 11. Hyperglycemia <ul><li>Causes </li></ul><ul><ul><li>Failure to take insulin </li></ul></ul><ul><ul><li>Overeating, eating wrong diet </li></ul></ul><ul><ul><li>Stress (fever, infection, emotional stress) </li></ul></ul>New-onset diabetics usually present with an episode of hyperglycemia
  12. 12. Diabetic Ketoacidosis <ul><li>Usually Type I diabetic (no insulin) </li></ul><ul><li>Blood sugar rises </li></ul><ul><li>Kidneys try to remove excess sugar </li></ul><ul><li>Urine production increases ( polyuria ) </li></ul><ul><li>Patient becomes volume depleted </li></ul><ul><ul><li>Thirst ( polydypsia ) </li></ul></ul><ul><ul><li>Tachycardia </li></ul></ul><ul><ul><li>Hypotension </li></ul></ul><ul><ul><li>Dry skin, mucous membranes </li></ul></ul>
  13. 13. Diabetic Ketoacidosis <ul><li>Cells cannot burn sugar; patient experiences hunger ( polyphagia ) </li></ul><ul><li>Cells burn fat as alternative fuel </li></ul><ul><li>Acidic ketone bodies produced </li></ul><ul><li>Patient tries to correct acidosis; exhales CO 2 </li></ul><ul><li>Rapid, deep breathing (Kussmaul respirations) </li></ul><ul><li>Exhaled ketone bodies produce nail-polish remover or “fruity” breath odor </li></ul>
  14. 14. Diabetic Ketoacidosis <ul><li>Volume depletion </li></ul><ul><li>Ketone body production (ketoacidosis) </li></ul>
  15. 15. Hyperosmolar Coma <ul><li>Usually Type II diabetic (inadequate insulin) </li></ul><ul><li>Blood sugar rises </li></ul><ul><li>Kidneys try to remove excess sugar </li></ul><ul><li>Urine production increases (polyuria) </li></ul><ul><li>Patient becomes volume depleted </li></ul><ul><ul><li>Thirst (polydypsia) </li></ul></ul><ul><ul><li>Tachycardia </li></ul></ul><ul><ul><li>Hypotension </li></ul></ul><ul><ul><li>Dry skin, mucous membranes </li></ul></ul>
  16. 16. Hyperosmolar Coma <ul><li>Cells continue to burn sugar </li></ul><ul><li>Acidic ketone bodies not produced </li></ul><ul><li>Nail-polish remover or “fruity” breath odor not present </li></ul>
  17. 17. Hyperosmolar Coma <ul><li>Severe volume depletion </li></ul><ul><li>NO ketone body production </li></ul>
  18. 18. Hyperglycemia <ul><li>Management </li></ul><ul><ul><li>Support ABC’s </li></ul></ul><ul><ul><li>Treat for hypovolemic shock </li></ul></ul><ul><ul><li>Transport </li></ul></ul><ul><ul><li>When in doubt, give sugar! </li></ul></ul>
  19. 19. Hypoglycemia <ul><li>Causes </li></ul><ul><ul><li>Insulin overdose </li></ul></ul><ul><ul><li>Normal insulin use without eating </li></ul></ul><ul><ul><li>Over-exercise </li></ul></ul>
  20. 20. Hypoglycemia Pale, cool skin; sweating; nausea; tachycardia Is that why hypoglycemia sometimes is called “Insulin Shock?”
  21. 21. Hypoglycemia <ul><li>Insulin shock isn’t really shock </li></ul><ul><li>Patient just looks “shocky” because of epinephrine adrenals are releasing </li></ul>
  22. 22. Hypoglycemia <ul><li>Can occur in non-diabetics </li></ul><ul><li>Most common cause = EtOH on empty stomach </li></ul><ul><li>A patient is never, just drunk </li></ul>
  23. 23. Hypoglycemia Management <ul><li>Conscious patient </li></ul><ul><ul><li>Give sugar orally </li></ul></ul><ul><li>Unconscious patient </li></ul><ul><ul><li>Support ABC’s </li></ul></ul><ul><ul><li>Get ALS back-up for IV glucose </li></ul></ul><ul><li>When in doubt, Give Sugar! </li></ul>
  24. 24. Ask All Diabetics <ul><li>Have you eaten today? </li></ul><ul><li>Have you taken your medication today? </li></ul><ul><li>When in doubt, give Sugar! </li></ul>
  25. 25. Other Diabetes Complications <ul><li>Atherosclerosis </li></ul><ul><ul><li>Myocardial infarction </li></ul></ul><ul><ul><li>CVA </li></ul></ul><ul><ul><li>Peripheral vascular disease </li></ul></ul><ul><ul><li>Blindness </li></ul></ul><ul><ul><li>Renal failure </li></ul></ul>
  26. 26. Other Diabetes Complications <ul><li>Diabetic Neuropathy </li></ul><ul><ul><li>Gangrene </li></ul></ul><ul><ul><li>Increased “silent” myocardial infarction risk </li></ul></ul>
  27. 27. Silent MI <ul><li>Acute MI in diabetic can present without chest pain </li></ul><ul><li>May resemble “flu” </li></ul><ul><li>Manage “sick” diabetics as if critically ill until proven otherwise </li></ul>

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