Diabetes is a disease caused by inadequate production of insulin. Insulin shock results from too much insulin causing low blood sugar, while diabetic coma results from not enough insulin causing high blood sugar. The goal in managing diabetes is to maintain target blood glucose levels. Signs of insulin shock include rapid pulse and confusion, while signs of diabetic coma include rapid breathing and dehydrated skin. Treatment involves monitoring vital signs, giving oral glucose if conscious, and transporting to advanced care. Diabetes is managed through balancing food, medication, exercise and monitoring blood glucose levels.

1. Barry Kidd 2010 1
Diabetes
HOW SWEET ARE YOU?

2. Barry Kidd 2010 2
Diabetes
Diabetes is a disease caused by the
inadequate production of insulin
Insulin Shock (hypoglycemia at it’s worse
case) results from too much insulin in the
blood, causing low sugar levels for the brain
and nervous systems
Diabetic Coma (hyperglycemia at it's worse
case) results from an inadequate insulin
supply that leads to unconsciousness, coma
and death if not treated

3. Barry Kidd 2010 3
Diabetes is Managed,
But it Does Not Go Away.
GOAL:
To maintain target
blood glucose

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Diabetic Coma (Hyperglycemia)
Hyperglycemia is a lack of insulin, this
causes too much sugar in the blood and
not enough in the cells
Causes:
 Too much food
 Not taken insulin
Insulin facilitates the transport of sugar

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Diabetic Coma (Hyperglycemia)

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Diabetic Coma (Hyperglycemia)
Signs and Symptoms…
 Rapid deep breathing
 Rapid weak pulse
 Decreased level of consciousness
 Dehydrated (dry), warm skin
 Sweet or fruity, (acetone) odor on breath
 Dry mouth and intense thirst
 Increasing restlessness, confusion
This onset of this condition is gradual over
a period of days

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Diabetic Coma (Hyperglycemia)
Care for the Patient…
 Keep at rest in position of comfort
 Obtain a good history (meals, insulin)
 High flow O2
 Reassurance
 If unsure whether insulin shock or diabetic coma, give
glucogel or instagel if patient has a patent airway
 Monitor vital signs
 Transport the patient to advanced medical care

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Insulin Shock (Hypoglycemia)
There is too much insulin, causing a lack
of sugar in the blood.
Some causes are:
 Not enough food
 Too much insulin
 Excessive exercise
Insulin facilitates the transport of sugar

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Insulin Shock (Hypoglycemia)

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Insulin Shock (Hypoglycemia)
Signs and Symptoms…
 Normal breathing
 Rapid, full pulse
 Decreased or altered level of consciousness
 Pale, moist skin (sweaty at times)
 Dizziness, headache
 Fainting
 Seizures
 Disorientation
 Coma
This onset of this condition is sudden, can occur
within minutes

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Insulin Shock (Hypoglycemia)
Care for Patient
 Keep at rest – position of comfort
 S-A-M-P-L-E history (Insulin, meals, etc.)
 High flow O2
 Monitor vital signs
 Nothing by mouth, unless their alert
 If unsure whether insulin shock or diabetic
coma, give the patient instagel or glucogel
 Transport patient to advanced care

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Constant Juggling:
Insulin/medication
with:
Exercise
Food intake
Diabetes Management 24/7
BGBG
BGBG
BGBG
&

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Diabetes
Gestational diabetes
Some women may develop gestational
diabetes during pregnancy. These
women are non-symptomatic before the
pregnancy. Generally, glucose levels
will return to normal after the pregnancy,
although there is a higher risk of
developing diabetes later in life

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Diabetes
There are many risk factors for
diabetes, including:
A parent, brother, or sister with diabetes
obesity
Age greater than 45 years
Some ethnic groups (particularly African-
Americans, and First Nation)

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Diabetes
Gestational diabetes or delivering a baby
weighing more than 9 pounds
High blood pressure
High blood levels of triglycerides (a type
of fat molecule)
High blood cholesterol level

16. Barry Kidd 2010 16
Diabetes
Measuring Glucose Level
Blood Glucose Level (BGL) is measured
in millimoles per litre (mmol/l), and a
normal BGL ranges from 4 mmol/l to 7
mmol/l. Hypoglycemia is most often
defined as a BGL of less than 4 mmol/l,
whereas hyperglycemia is defined as a
BGL of greater than 7 mmol/l.

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Diabetes
To accurately check someone’s BGL,
use a device called a glucometer. Use
this reading, along with a patient’s
history and any signs and symptoms
found during assessment, to determine
whether to treat the situation as a
diabetic emergency.

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Diabetes
How to use the Glucometer
 Prepare the lancet and lancet device
 Let the patient’s arm hang to the side if
possible
 Remove a new test strip from the vial
and insert it into the device
 Match the code number on the screen to
that of the test strip vial

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Diabetes
 Cleanse the finger and force blood to the
finger by squeezing the finger
 Prick the side of the finger and gently squeeze
out a drop of blood
 Drop the blood onto the test strip in the
appropriate place, cover lancet site with a
Band-Aid
 Record the BGL reading
 Remove the test strip and dispose into a
biohazard bag

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QUESTIONS
5148
1: Which of the following is a common
sign or symptom of a patient
experiencing a diabetic emergency?
A: Slow pulse
B: Pale, clammy skin
C: Elevated blood pressure
D: Decreased respiratory rate

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ANSWERS
 B: Pale, clammy skin

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QUESTIONS
2: Altered mental status that often
accompanies diabetic emergencies is often
mistaken for:
A: a migraine.
B: alcohol intoxication.
C: a severed spinal cord.
D: a swollen or deformed lower extremity.

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ANSWER
B: alcohol intoxication.

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QUESTIONS
3: Diabetes is considered a disease of
balance because the patient must try to
balance:
A: food intake with glucose therapy.
B: medication with charcoal intake.
C: medication to stimulate the liver with fat
intake.
D: the need for glucose with the available
insulin supply.

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ANSWER
A: food intake with glucose therapy.

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QUESTIONS
4: Which of the following conditions can occur
if an unconscious patient is given oral
glucose?
A: Shock
B: Aspiration
C: Hypotension
D: Hyperglycemia

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ANSWER
B: Aspiration

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QUESTIONS
5: Diabetes is caused by the body's lack of
adequate amounts of:
A: sugar.
B: insulin.
C: glucose.
D: aspartame.

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ANSWER
B: insulin.

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QUESTIONS
6: The form of diabetes that develops as a
person ages is called:
A: type I diabetes.
B: type II diabetes.
C: type III diabetes.
D: adult sugar disorder.

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ANSWER
 B: type II diabetes.

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QUESTIONS
7: Which of the following will probably NOT
cause a diabetic emergency in a patient with a
history of diabetes controlled by medication?
A: Eating a regularly scheduled meal
B: Unusual exercise or fatigue
C: Overeating
D: Infection

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ANSWER
A: Eating a regularly scheduled meal

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QUESTIONS
8: Oral glucose should be placed:
A: on the tongue of a conscious patient.
B: on the tongue of an unconscious patient.
C: between the cheek and gum of a conscious
patient.
D: between the cheek and gum of an
unconscious patient.

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ANSWER
C: between the cheek and gum of a
conscious patient.

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QUESTIONS
9: The term "polyuria" can be defined as
frequent:
A: seizure activity.
B: bouts of depression.
C: Urinating excessively.
D: drinking to satisfy continuous thirst.

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ANSWER
 C: Urinating excessively.

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QUESTIONS
10: What waste products are formed when fat
is used for energy?
A: Pancreatic acids
B: Glucose and carbon dioxide
C: Glucose and fatty acids
D: Ketones and fatty acids

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ANSWER
 D: Ketones and fatty acids