There are approximately 304 million people living in the United States.  It is estimated that 24 million of us currently have diabetes.  That is 7.8% of the population, making diabetes a disease we should all be aware of and familiar with.  Many of us have family or friends with diabetes, yet many people don’t know much about it at all.  As firefighters and EMT’s hypoglycemia is one of the most common medical situations faced. This report will supply an overview of the disease.

Diabetes is a disease which affects a person’s ability to produce or use insulin.  This typically results in either a shortage or overabundance of glucose within a persons blood stream.  These situations are known respectively as hypoglycemia and hyperglycemia.  Both of these conditions can be fatal if left untreated; or can cause of a number of other problems including blindness, heart disease, nerve damage, and kidney problems. Fortunately, if symptoms are recognized early, both can be effectively managed.

Insulin is a hormone produced in the pancreas and has many purposes, the most significant of which may be the utilization of glucose for metabolism and body functions.  When the body produces normal amounts of insulin, sugars are utilized and the body functions normally.  If insulin levels in the body become low, glucose continues to build to abnormally high levels (hyperglycemia).  Conversely, when the pancreas produces too much insulin, or a person does not consume enough (and the right kinds of) food to supply adequate blood-sugar levels, hypoglycemia occurs.

Most people have a properly functioning pancreas which produces proper amounts of insulin based on the bodies needs.  Still, a number of factors including health, genetics, diet, age and simple luck, result in so many American’s becoming the victims of this incurable disease.  Most people develop it later in life, though some very unfortunate people are born with it.

Diabetes symptoms

Symptoms of Type I & II diabetes.

Type II diabetes, also known as “adult onset diabetes” is the most common form and is usually the result of aging, obesity, poor diet, and lack of exercise.  African Americans and Hispanics, among other nationalities tend to be at higher risk.  While we have no control over many of these factors, there are some we do have control over.  Diet and exercise (or lack of) may be two of the biggest factors contributing to the soaring numbers of new cases of diabetes each year.  Eating right and exercising regularly will cut a person’s chances of getting type II diabetes down hugely.  Bottom line: Healthy eating and regular exercise can be a cure for type 2 diabetes.

Type I diabetes is not preventable as Type II is, but it affects a much smaller portion of the population as well.  Type I or “Juvenile diabetes” occurs when the bodies own immune system attacks the pancreas destroying its ability to produce insulin.   In these cases, the diabetic must rely on supplemental insulin, usually in the form of injections, to manage their blood-glucose levels.

Recognizing diabetes can be tricky as its symptoms often mimic those of other problems.  Diabetics are often mistaken for drunks, drug users or crazy people because of their sudden strange and bizarre behavior, which is often aggressive in nature.  Both types share many of the same signs and symptoms such as an altered mental status, frequent urination, hunger, impaired vision and drowsiness or dizziness.

Telling hyper and hypoglycemia apart isn’t always easy, but there are a few signs which can often help differentiate the two.  In hyperglycemia, the patient will need to urinate often as his body works to eliminate the abundance of sugar in their system.  This excessive sugar may be noted as sweet or fruity smelling breath. As a result of their frequent urination, the patient may become dehydrated which may lead to dry skin.  Be alert for dry skin, sweet breath, and frequent urination.

Hypoglycemia tends to be more common and is recognizable by the patients shaky disposition and pale, cool and diaphoretic skin.  They will likely have a rapid pulse and normal to low blood pressure and respiratory rate.  The patient will also appear dizzy or unstable and complain of headaches.

As an firefighter/EMT, treating diabetic patients usually involves administering some form of sugar (preferably medical grade oral glucose) orally.  Oral glucose is usually the easiest and most appropriate solution for hypoglycemia, though it can only be done if the patient is still conscious enough to follow simple directions.  If the patient is not capable of feeding themselves oral glucose or some other sugary food or drink, they will need glucose by means of IV.  At this point, rapid transport to a hospital is necessary.  In hospital treatment for hypoglycemia includes glucose replacement and monitoring.

Treating a diabetic with hyperglycemia would mean getting him to take his insulin if capable.  Being that EMT’s are not authorized to administer shots, rapid transport to the hospital would be required where the patient would be treated with the appropriate dose of insulin.

In both cases, test the patients’ blood glucose levels if their glucometer is available (and if local protocol allows), check for insulin, medications and medical alert tags on or around the patient, and always provide high flow oxygen.  Continuously monitor the patients LOC and check vital signs regularly (every 5 minutes during the diabetic episode and following interventions).