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Diabetes Mellitus

• The most common endocrinopathy

• One of the most common causes for EMS response.

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Cardinal Symptoms of Diabetes

• Polyuria• Polydypsia• Polyphagia

3 P’s

GTT Fasting

Diagnosing Diabetes

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PathophysiologyOf Diabetes

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Blood Sugar Balance

Pancreatic B Cells

Pancreatic A Cells

Type 1 Diabetes(inability to produce Insulin)

• Less common (20%)

• Before age 40• More severe• Always need

Insulin• Etiology?

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Treatment type 1 Diabetes

Electron micrograph of peptide hormone Insulin

The issue is Insulinproduction

Insulin’s Actions

• Increases cellular transport of Glucose (also K+ and Amino Acids)

• Converts Glucose to Glycogen (for storage in the liver and muscles)

• Promotes Cell Growth

insuliThe Insulin Bus

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Insulin Preparations

Type 2 diabetes

• More common (80%)

• Usually >40 yrs• End organ

insensitivity• Obesity• Familial

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Treatment type 2 Diabetes

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Medical Treatment Type 2 Diabetes Mellitus• Oral agents

1. Sulfonylureas2. Biguanides3. Thiazolidinediones4. Alpha-glucosidase inhibitors

• Insulin

Glitazones(Actos & Avandia)

Metformin(glucophage)

Orinase, DiabineseGlucotrol (glipizide)Glyburide (micronase)

These only work in type 2 Diabetes

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Gestational Diabetes

• Stress induced• Transient• Can be a precursor

to Diabetes Mellitus later in life

Prehospital Concerns

• Hypoglycemia (rarely occurs in people who aren’t on DM meds)

• Diabetic Ketoacidosis

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Mild to moderateSweating Trembling Hunger Rapid heartbeat

SevereConfusion Weakness Disorientation Combativeness In rare and worst cases, coma, seizure, and death

Symptoms of Hypoglycemia

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Less likely to work if depleted glycogen stores

Diabetic KetoacidosisDKA

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Prehospital Treatment of DKA

• Acidosis

• Volume & Vascular Resistance

• Nausea, Vomiting, & Abdominal pain

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A messagefrom the

Spokane CountyEMS

QI Committee

Post Test• 1. What are the three giveaways for suspecting new onset of

Diabetes?– A. Excessive sweating, malaise, weakness– B. Excessive thirst, hunger, and urination.– C. Salivation, Lacrimation, Urination– D. High blood pressure, slow pulse, breathing irregularities– E. Headache, nausea/vomiting, decreased LOC.

• 2. Number, in order of priority, the steps to take if an unresponsive diabetic is found.– A.___ Smear some honey (or high glucose concentration) on the inside

of their cheeks.– B___ Get their hips higher than their head.– C___ Attempt to get a blood glucose reading.– D___ Protect their airway.– E___ Place them in the recovery position– F___ Ensure scene safety/security.

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• 3. Our index of suspicion should be increased for what types of medical conditions with a history of diabetes?– A. Breathing problems.– B. Circulatory problems.– C. End organ failure.– D. A and B above.– E. All of the above.

• 4. When is it appropriate to obtain a blood glucose level during a cardiac arrest in a known insulin dependent diabetic?– A. After the patient has been stabilized.– B. It is the first thing you should do.– C. As soon as possible without compromising life saving efforts.– D. It is not necessary... you should always give glucose to a dead

diabetic.– E. Prior to "calling the code" so you know you're not missing

something.• 5. True or False... even though D50W is extremely irritating to

veins it can be safely administered through an Intraosseous infusion.– T F

Renee Andersonandersr@inhs.sorgFax 509-232-81441-888-258-9632

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The End