The document summarizes a PowerPoint presentation on diabetes and altered mental status. It discusses the anatomy and physiology of the pancreas, the roles of insulin and glucagon in maintaining normal blood glucose levels, signs and symptoms of hypo- and hyperglycemia, diabetic disorders, and protocols for assessing and treating altered mental status and hypoglycemia. Key points covered include the cellular effects of insulin and glucagon, signs of hyper- and hypoglycemia, common causes of each, and guidelines for performing a blood glucose check and administering oral glucose if indicated for a diabetic patient with altered mental status.

2. Powerpoint Presentation/ Topics Discussed
•Anatomy & Physiology of Pancreas and basic cellular needs (normal individuals)
•glucagon, insulin discussed
•Cellular needs for blood glucose and effects of not efficiently maintaining
•Clinical signs and symptoms of hypo/hyperglycemia
•Diabetes and other compromising metabolic health concerns as a result of blood glucose
imbalances, some disorders, common situations discussed in more depth
•Cellular Metabolism briefly reviewed
•Normal and abnormal blood sugar levels as per age range
•Hyperglycemia: signs, symptoms and treatments
•Hypoglycemia: signs, symptom and treatments
•Review of BLS Altered Mental Status/ Diabetic protocols
•Indication for Blood Glucose Check and Glucometer Use

3. The pancreas has two main jobs in the body:
1)To produce juices that help digest (break
down) food.
2)To produce hormones, such as insulin and
glucagon, that help control blood sugar levels.
Both of these hormones help the body use and
store the energy it gets from food.

4. Glucagon is an important hormone involved in
carbohydrate metabolism. Produced by the
pancreas, it is released when the glucose level in
the blood is low (hypoglycemia), causing the liver
to convert stored glycogen into glucose and
release it into the bloodstream. The action of
glucagon is thus opposite to that of insulin, which
instructs the body's cells to take in glucose from
the blood in times of satiation.
*glucagon is naturally occurring in the body, but
can also be synthetically made and given to
patients

5. Insulin is a hormone with intensive effects on both
metabolism and several other body systems (eg,
vascular compliance). Insulin causes most of the
body's cells to take up glucose from the blood
(including liver, muscle, and fat tissue cells),
storing it as glycogen in the liver and muscle, and
stops use of fat as an energy source.
*Insulin is naturally occurring in normal functioning
pancreas, but can also be given as a medication to
patients

7. Hyperglycemia (high blood
sugar) is a slow-onset
condition from decreased
insulin levels in people with
diabetes.

8. Slow onset
Nausea/vomiting
Acetone odor on breath (DKA)
Increased urination/hunger/ thirst
Some patients present differently
DKA: diabetic keto-acidosis

9. Forgotten or insufficient insulin dose
Infection
Stress
Increased dietary intake

10. Hypoglycemia (low blood sugar) is a life-
threatening emergency for people with
diabetes.
It is the most common emergency for the
diabetic patient.

11. Rapid onset
Intoxicated appearance, staggering, slurred
speech, unconsciousness
Cold, clammy skin
Rapid heart rate
Seizures (severe cases)
Unusual or bizarre behavior
Anxiety
Refusal to cooperate or combativeness
CVA/TIA signs and symptoms

12. After taking too much insulin
Vomiting
After unusual amount of exercise
Reduced sugar intake by not eating
Some disease processes can also cause

13. The condition brought about by
decreased insulin production, or
the inability of the body cells to
use insulin properly (which
prevents the body’s cells from
taking the simple sugar called
glucose from the bloodstream)

14. Gestational diabetes (or gestational
diabetes mellitus, GDM) is a condition in
which women without previously diagnosed
diabetes exhibit high blood glucose levels
during pregnancy.

15. Diabetes insipidus (DI) is a condition
characterized by excretion of large amounts of
severely diluted urine, which cannot be
reduced when fluid intake is reduced. It
denotes inability of the kidney to concentrate
urine

16. Diabetes mellitus type 1 (Type 1 diabetes,
Type I diabetes, juvenile diabetes) is a form of
diabetes mellitus. Type 1 diabetes is an
autoimmune disease [1] that results in the
permanent destruction of insulin-producing
beta cells of the pancreas. No insulin is
produced naturally.

17. Diabetes mellitus type 2 or Type 2 Diabetes
(formerly called non - insulin-dependent
diabetes mellitus (NIDDM), or adult-onset
diabetes) is a metabolic disorder that is
primarily characterized by insulin resistance,
relative insulin deficiency, and hyperglycemia.

18. Get a SAMPLE history.
If the patient has a history of diabetes:
When did patient last eat?
Any medications? Last taken?
Any other illnesses?

19. Blood
Glucose
Meters

24. 80-120 mg/dl Normal
60-80 mg/dl Moderate hypoglycemia
Below 50 mg/dl Severe
hypoglycemia
Above 140 mg/dl Hyperglycemia
Question results that are inconsistent
with patient’s condition.

25. Meter not calibrated
Low batteries in meter
Improperly stored or expired test strip
Insufficient blood on test strip

26. Hypoglycemia
Poisoning (including alcohol & drugs)
Infection
Head trauma
Hypoxia

27. Commonwealth of Massachusetts 10.01 Official Version DPH/OEMS 3.3
ALTERED MENTAL/NEUROLOGICAL STATUS
An alteration in mental/neurological status is the hallmark of central
nervous system (CNS) injury or illness. Any alteration in
mental/neurological status is abnormal and warrants further examination.
Altered mental/neurological status may be due to many factors. A common
grouping of causes for altered mental/neurological status is the following:
A E I O U – T I P S; Alcoholism, Epilepsy, Insulin, Overdose, Underdose,
Trauma, Infection, Psychiatric and Stroke.
Altered mental/neurological status may present as mild confusion or
complete unconsciousness (coma). Altered mental status may be a result of
a medical condition, traumatic event, or both. EMS agencies should use the
Glasgow Coma Scale (GCS) or AVPU for their ongoing neurological
assessment, as appropriate for the possible causes of the patient's
condition.
Note that GCS has been validated as a predictor of outcome specifically for
trauma.
NOTE: See also Protocols for Diabetic Emergencies; Toxicology/Poisoning;
Seizures; Shock; Syncope; and/or Head Trauma/Injury.

28. ASSESSMENT / TREATMENT PRIORITIES
1. Ensure scene safety and maintain appropriate body substance
isolation precautions.
2. Maintain open airway and assist ventilations as needed.
Assume spinal injury when appropriate and treat accordingly.
3. Administer oxygen using appropriate oxygen delivery device, as
clinically indicated.
4. Determine patient's hemodynamic stability and symptoms.
Continually assess Level of Consciousness, ABCs and Vital Signs.
5. Obtain appropriate S-A-M-P-L-E history related to event.
6. Monitor and record vital signs and ECG.
7. Initiate transport as soon as possible, with or without ALS. Do
not allow patients to exert themselves and properly secure to cot
in position of comfort, or appropriate to treatment(s) required.

29. TREATMENT BASIC PROCEDURES
1. BLS STANDING ORDERS
a. If authorized and trained to do so perform Glucometry reading.
b. If patient is a known diabetic who is conscious and can speak
and swallow, administer oral glucose or other sugar source as
tolerated. One dose equals one tube. A second dose may be
necessary. (SEE Diabetic Protocol)
CAUTION: Do NOT administer anything orally if the patient
does not have a reasonable level of Consciousness and
normal gag reflex.
CAUTION: If cerebrovascular accident is suspected, contact
Medical Control
c. If patient is unconscious or seizing, transport on left side
(coma position).
d. If patient’s BLOOD PRESSURE drops below 100mm Hg
systolic: treat for shock.
e. Notify receiving hospital.