What are diabetic emergencies?
A diabetic emergency occurs when symptoms of poorly controlled Diabetes overwhelm the body. Usually, at this point, home treatment is of little help and any delay in medical care could be life threatening or cause permanent damage. If there are any signs of a Diabetic emergency, the person should call for help to get to the hospital ASAP or someone with them should make sure they get them to the hospital.
Blood sugar levels fluctuations, skipped meals, accidental medicine overdose, or a lot of vigorous exercise can result in emergencies among diabetic patients. Since a diabetic’s body is sensitive to glucose fluctuations, such factors can cause serious cases of hypoglycemia and hyperglycemia. Some of the common diabetic emergencies include:
Severe hypoglycemia;
Diabetic Ketoacidosis;
Hyperosmolar Hyperglycemic State; and
1) Severe Hypoglycemia
Blood sugar less than 3.9mmol/L is low and can lead to complications if not checked. Most of the time, at these readings, the patient is usually conscious and can take the necessary steps to rectify the hypoglycemia – Taking 15 grams of a fast acting carbohydrate and checking the blood sugar readings after 15 minutes. This should be repeated until the blood sugar level is above 3.9mmol/L after which you can have a healthy meal.
However, a blood sugar reading of less than 3.0mmol/L is termed as severe hypoglycemia mostly because at this point, the patient might need somebody else to help them recover. Taking a fast-acting carbohydrate is not an option at this point if the patient is unconscious since it might cause choking. Injectable glucagon is usually injected in the arm, buttock or thigh to treat severe hypoglycemia. Glucagon is a hormone that usually stimulates the liver to release stored glucose into the blood stream. If unavailable, the patient should be rushed to the nearest hospital. The patient SHOULD NOT BE INJECTED WITH INSULIN since it will only make a bad problem worse.
Causes
inadequate carbohydrate consumption
Accidentally injecting too much insulin, the wrong insulin type or injecting directly into the muscle instead of just under the skin
Intensity, Duration and timing of exercise. Engaging in high duration and intensity of exercise without appropriate fueling (carbohydrates) and timing exercise when blood sugars are very low or when insulin activity is at its peak can all lead to severe hypoglycemia
Overdosing on oral glucose medications. Work with your doctor to get the right dose.
Excessive alcohol consumption
Symptoms range from:
Unease
Sweating
Increased appetite
Trembling
Headaches
To:
Aggressiveness
Confusion
Seizure
Unconsciousness
2) Diabetic Ketoacidosis
Diabetes patients, especially Type 1 Diabetes patients, are prone to Diabetic Ketoacidosis.It occurs because of minimal or insufficient insulin supply to allow glucose to enter cells efficiently. This in turn raises blood sugar levels and since the body cannot utilize the sugar,it breaks down fat and produces ketone bodies. High levels of ketones in the body is dangerous since it raises the acidity level of the blood, making the blood poisonous.
Symptoms include
Thirst
Deep breathing (Kassmaul breathing)
Abdominal pain
Acetone/fruity smelling breath
Unconsciousness
Comma
Extreme thirst or a dry mouth
Frequent urination
Causes/Triggers:
Infections
Noncompliance to insulin treatment protocols or inadequate insulin treatment
Having undiagnosed diabetes
Obstructed blood vessels (infarctions)
Pregnancy
Certain medications such as steroids and diuretics.
If ketone tests shows the presence of ketones in the urine and blood glucose is more than 16mmol/L and not coming down despite injecting insulin or taking oral medication, then you need to go to the hospital or have someone take you to the hospital immediately.
3) Hyperglycemic Hyperosmolar State (HHS)
HHS often occurs in people with poorly controlled type 2 Diabetes. Hyperglycemic Hyperosmolar State is characterized by severe hyperglycemia (greater than 33.3mmol/L), hyperosmolality (greater than 320mmol/kg) and dehydration in the absence of ketoacidosis.
Normally, the kidneys try to make up for a high blood glucose level by releasing the extra glucose through urine. This also causes the body to lose water leading to severe dehydration if not rectified. This loss of water makes the blood more concentrated with salt(sodium) and glucose than normal. This is what is referred to as hyperosmolality and at this state water is continuously drawn out of other body organs including the brain, completely impairing their functionality.
Symptoms include:
storing unopened insulin on its side in a fridge
keeping the fridge temperature between 2 and 8°C
making sure that insulin does not freeze
once opened, keeping it at room temperature (less than 25 °C) for not more than one month and then disposing it off safely
Extreme (hot or cold) temperatures can damage insulin and render it useless. It must not be left where temperatures are over 30 °C.
There are various insulated carry bags available for transporting insulin.
Causes/Triggers:
Infections including pneumonia, stroke, sepsis, urinary tract infection, myocardial infarction
Medication such as steroids, β-blockers, and thiazide diuretics
Not taking prescribed diabetes drugs or insulin
Poor kidney function
Having undiagnosed diabetes
Generally, patient education is very important for diabetic emergency patients to prevent recurrence and instill the relevance of equating insulin doses to carbohydrate intake. Therefore, glycemic control is very important in preventing diabetic emergencies. Patients who are taking insulin must base the doses on carbohydrate consumption and perform blood glucose tests regularly. Besides, most of the emergencies are due to inflammation caused by cytokines and Reactive Oxygen Species, therefore patients should increase consumption of antioxidant vitamins such as vitamin A, E, and C abundantly available in fruits and vegetables.
Engaging in regular physical activity (well planned) and taking medication as prescribed will also go a long way in minimizing the occurrence of diabetic emergencies.
It is also advisable that people with diabetes have a medical ID (could be a bracelet or necklace) with them to provide critical information such as diabetes status, allergies and therapy being used. This can be of vital importance when the patience is unconscious and cannot communicate these details during a diabetic emergency.
