References
Continuing Professional Development: Diabetes and associated diabetic emergencies
Abstract
Overview
Diabetes is a group of metabolic diseases characterised by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic complications of diabetes include accelerated development of cardiovascular disease, end-stage renal disease, loss of visual acuity, and limb amputations. However, in the acute situation, diabetes can result in conditions such as diabetic ketoacidosis and hyperosmolar hyperglycemic state, both of which have the same cause: insufficient insulin. This article explores the physiology of glucose control, the pathophysiology of diabetes and the role of the paramedic in the prehospital treatment of the diabetic emergencies, diabetic ketoacidosis and hyperosmolar hyperglycemic state.
After completing this module, the paramedic will be able to:
You are called to attend a 19-year-old female known diabetic, who has had episodes of vomiting and retching for the past hour. Her mother explains that she usually becomes unwell during her menstrual cycle, when her blood sugar rises, which is normally well controlled by her insulin. Today she has persistent episodes of nausea and vomiting. Her baseline observations are as follows:
According to the World Health Organization (WHO) (2018a), diabetes is a chronic, metabolic disease characterised by elevated levels of blood glucose, which leads over time to serious damage to the heart, blood vessels, eyes, kidneys, and neurones. The most common is type II diabetes, usually in adults, which occurs when the body becomes resistant to insulin or does not make enough insulin. In the past three decades, the prevalence of type II diabetes has risen dramatically in countries of all income levels (WHO, 2018b).
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