Diabetic Emergencies

Glucose is the end product of carbohydrate metabolism. Its serves as the chief source of energy to carry out normal body functions and to assist in maintaining body temperature. The body maintains a constant blood glucose level to ensure a continuous source of energy for the * body. Glucose that is not needed lor energy can be stored in the form of glycogen in muscle and liver tissue for later use. When no more tissue storage is possible, excess glucose is converted to fat and stored as adipose tissue.

Insulin is a hormone secreted by the beta cells of the pancreas and is required for normal use of glucose in the body. Insulin enables glucose to enter the body's cells and be converted to energy. Insulin is also needed for the proper storage of glycogen in liver and muscle cells.

Diabetes mellitus is a disease in which the body is unable to use glucose for energy due to a lack of insulin in the body. There are two types of diabetes: a severe form, usually appearing in childhood, known as type 1 diabetes, and a mild form, usually appearing in adulthood, known as type 2 diabetes. Most individuals with diabetes (90%) have type 2 diabetes. There is no cure for diabetes mellitus, but significant advances have been made in controlling the disease through a combination of drug therapy, diet therapy, and activity. The goal for the diabetic patient is to balance food intake and level of activity with the body's insulin.

Two types of emergency can be experienced by a diabetic patient: hypoglycemia, commonly referred to as insulin shock, and diabetic ketoacidosis, commonly known as diabetic coma.

Insulin shock (hypoglycemia) occurs when there is too much insulin in the body and not enough glucose. Insulin shock can be caused by administration of too much insulin, skipping meals, and unexpected or unusual exercise. The symptoms of insulin shock are normal or rapid respirations; pale, cold, and clammy skin; sweating; dizziness and headache; full rapid pulse; normal or high blood pressure; extreme hunger; aggressive or unusual behavior; fainting; and seizure or coma. The onset of insulin shock occurs rapidly, usually over a period of 5 to 20 minutes, after the blood glucose level begins to fall. Because the brain requires a constant supply of glucose for proper functioning, permanent brain damage or even death can result from severe hypoglycemia.

Diabetic coma (diabetic ketoacidosis) occurs when there is not enough insulin in the body. This causes the blood glucose level to rise, resulting in hyperglycemia. When glucose cannot be used for energy, fat is broken down. This results in a buildup of acid waste products in the blood, known as ketoacidosis. The combined effect of the hyperglycemia and ketoacidosis causes the following symptoms: polyuria, excessive thirst and hunger, vomiting, abdominal pain, dry, warm skin, rapid and deep sighing respirations, a sweet or fruity (acetone) odor to the breath, and a rapid, weak pulse.

If the condition is not treated, diabetic coma can progress to dehydration, hypotension, coma, and death. Unlike insulin shock, however, the onset of diabetic coma is gradual, usually developing over a period of 12 to 48 hours. Diabetic coma can be caused by illness and infection, overeating, forgetting to administer an insulin injection, or administering an insufficient amount of insulin.

Most individuals with diabetes have a thorough knowledge of their disease and manage it effectively. Because of this, diabetic emergencies are most apt to occur when there is an unusual upset in the insulin/glucose balance in the body, such as might be caused by illness or infection. An emergency situation may also arise in an individual who has diabetes but in whom the condition has not yet been diagnosed.

It may be difficult to tell the difference between insulin shock and diabetic coma because the symptoms are similar. Often a patient suffering from either of these conditions appears to be intoxicated, If he or she is conscious, the diabetic patient usually knows what the trouble is; therefore, you should listen carefully to the patient to determine what may have caused the problem (e.g., not eating, forgetting to administer an insulin injection). If the patient is uncon­scious, and therefore unable to communicate, you should observe the patient's respirations. A patient in insulin shock has normal or rapid respirations, whereas a patient in diabetic coma has deep, labored respirations.

Most diabetic patients carry an emergency medical identification to alert others to then- condition when they cannot; examples include a medical alert bracelet or necklace, and a wallet card.