More than 30 million people in the US suffer from diabetes according to the National Diabetes Statistics Report. It's also one of the most common diseases worldwide. Because diabetes cases are rising, ER visits by diabetic patients have gone up. So, there’s a greater chance you'll need to give first aid to someone with diabetes when needed.Here we shed light on everything about diabetes, how to deal with it, and how to care for patients.
Understanding diabetes:
First responders have important choices to make before treating someone with diabetes. The best way is to fully understand their medical condition. All body cells need glucose as their main energy source. Diabetics need glucose but can't digest sugars or process them well. That's because their pancreas either produces little insulin or none at all, causing glucose to build up dangerously in the blood. A healthy pancreas controls insulin based on blood glucose levels. If it malfunctions, patients must take regular insulin from outside (medication).
Diabetes classification:
Type 1 diabetes is classified as an autoimmune disease mostly seen in kids and young people. Their bodies do not produce insulin at all, so they need regular insulin injections to help process glucose. Without insulin shots, they can't use the sugar in their blood for energy.
People with type 2 diabetes produce some insulin or their body can't use insulin properly, which is called insulin resistance. Many manage type 2 diabetes with diet, exercise, and other non-insulin meds. Still, some might need extra insulin too.
Emergencies in diabetic patients:
It's common for some diabetics to have situations with too much or too little insulin in the body, which is life-threatening. Too much insulin lowers blood sugar, while too little insulin raises blood sugar.
Tracking signs and symptoms of low or high blood sugar can help know if a person's blood sugar is too low or too high.
Low blood sugar:
Diagnosing low blood sugar depends on the cause, severity, and duration. Diagnosis is great if caught and treated early. Without treatment, low blood sugar can cause seizures or unconsciousness.
Low blood sugar happens faster than high blood sugar. When levels drop below 70 mg/L, the brain is denied vital glucose, leading to unconsciousness and then death.
Causes of low blood sugar:
- Taking medicines that cause low blood sugar.
- Not eating enough food, or following a diet low in nutrients.
- Sudden increase in activity level.
- Body needs more energy because of cold or tiredness.
Signs and symptoms of low blood sugar:
- Sweaty and pale skin.
- Breathing fast and shallow.
- Heartbeat speeds up.
- Feeling weak and tired.
- Headache.
High blood sugar (diabetic ketoacidosis):
Diabetic ketoacidosis (DKA) is a serious condition usually caused by blood sugar levels over 130 mg/L. Many experts recommend checking for ketones in urine when blood glucose is over 240 mg/L because if untreated it can cause coma or even death.
When blood sugar is high, the body switches to using fat for fuel like during fasting. Normally, when glucose is absent, the body breaks down fat for energy which produces ketones. This happens when the body doesn't produce enough insulin to handle the high sugar levels.
Causes of increased ketone levels:
- Not enough insulin in the blood, or not taking insulin properly.
- Getting sick or exhausted like dehydration, vomiting, infection, or fever.
- Some medications like steroids.
Signs and warning symptoms:
- Dry mouth
- Feeling thirsty
- Frequent urination
- High blood sugar level
- High ketones in urine
- Dry or flushed skin
- Feeling tired
- Pain in the belly area
- Throwing up and feeling sick
- Trouble breathing
Hyperglycemic Hyperosmolar Syndrome (HHS):
HHS is one of the severe complications that can be life-threatening for type 2 diabetes patients. It's different from DKA because HHS has very high blood sugar but no ketones. Though rarely, a small amount of ketones might build up. This syndrome can be caused by stress illnesses like infections, heart attacks, or strokes. Some medicines that affect insulin levels can also cause it. Plus, things that make you lose fluids lead to thicker blood. Since blood then has high levels of sodium, glucose, and other stuff, water gets pulled out from vital organs including the brain, which can cause death.
Signs and symptoms (early in the syndrome):
- More thirst and peeing
- Dry mouth
- Nausea
- Fever
- Weight loss
- Feeling weak
Signs and progressive symptoms (the condition may develop over days or even weeks):
- Seizures
- Feeling confused
- Speech trouble
- Loss of some muscle functions
- Movement problems occur
- The patient goes into a coma
Steps to take when giving first aid:
Knowing if someone has diabetes is very important when giving first aid. Often, people with diabetes wear or carry an ID or a tag like a bracelet to alert first aid providers. They might also have sugar sources like glucose tablets handy.
The following questions can help decide what to do when giving first aid to a diabetic patient:
- Have you eaten recently? What did you eat?
- Have you done any physical activity recently?
- When did you get your last insulin dose?
- Did you take any medicine today?
- Do you have new medicine and haven't taken it?
- Do you have a device to measure your sugar? If you have the device, help this person test their blood glucose level.
If the person ate but didn't take their medicine, it's likely high blood sugar. If they didn't eat but took their medicine, it's likely low blood sugar. Low blood sugar is more common than high because the body keeps burning energy. So, in theory, people are more at risk for low blood sugar. People not yet diagnosed with diabetes are more at risk for high blood sugar since they don't have devices or medicine yet.
First aid for someone with low blood sugar:
If the person is unconscious, don't give them food, drinks, or even put your hand in their mouth. But if the person is conscious, follow these steps:
- Don't give the patient insulin. it can drop their blood sugar level more.
- Give the patient 15-20 grams of simple carbs, sugar, or glucose.
- Check blood sugar again after 15 minutes if you can, and repeat the steps if it's below 70 mg/dL.
- Once blood sugar is normal, ask the patient to eat a small snack.
- Some people might have a glucagon kit for blood sugar emergencies. Glucagon is a hormone that tells the liver to release stored glucose into the blood when sugar is very low. Use the kit exactly as the instructions say.
Examples of 15 grams of simple sugar:
- Glucose gel or tablets
- 1 tablespoon of cane sugar or honey
- 2 tablespoons of raisins
- Hard candy or gum
- Half a cup of juice or non-diet soda
How to give first aid to someone with high blood sugar:
In any emergency, quick response is key. So having a clear emergency action plan is a good way to speed up your reaction. It's recommended to follow these steps:
- Stay calm
- Assess the person and the situation
- Call emergency services if the person is unconscious or not responding.
- Follow standard first aid steps, and if the patient doesn’t respond, check their circulation, airway, and breathing.
- If the person is unconscious but breathing and has no other life-threatening conditions, put them in the recovery position.
- If the person is unconscious and shows life-threatening signs, lay them flat on their back on a level surface and start CPR.
First aid kits:
It might help to have a glucose source in your first aid kit, especially if you work with diabetics or in a physical job, since low blood sugar can happen even without diabetes. Signs include weakness, sweating, tiredness, anger, and hunger.
