Diabetes

Diabetes Mellitus

Alexander Wallbrett

October 20, 2006

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It had not been fifteen minutes since I started my shift and already my pager was going crazy. The pager simply read: 56 year-old male, Altered LOC. The possibilities of what we might encounter began running through my mind. Had he been using drugs or was it a medical condition? My mind could not stop even as we arrived on scene. It was not until I saw the patient that I was able to rule out some of my prior assumptions. The patient was exhibiting many signs of distress: his respirations were at 32 shallow and ineffective, his skins were pale, moist and diaphoretic. His pulse was 120 bpm and his blood pressure was 90/50. He was only oriented x1, to his person. There were no family members at home and with so little knowledge of his past medical history, I had to slowly piece together possible causes of the problem and solutions of what could be done to help him. The patient's orientation made it difficult for him to volunteer much information but as he attempted to answer my questions, he mumbled that he had been vomiting for two days and that he had taken insulin this morning. This was an instant trigger for me that the man might be experiencing a diabetic problem, most likely insulin shock. This happens when a person takes insulin to control the amount of glucose (sugar) that enters their cells and for some reason is unable to keep their body's glucose at a minimum level. For example, the patient had been vomiting and was not able to keep food in his system, so there is a large build up of insulin that takes glucose from wherever it can, causing the body to break down all of its stored fat in order to compensate for the absence of glucose. There is a very limited amount of sugar in the body so after a couple of hours without food, one's body runs out of glucose and start's to go into insulin shock. Right away I placed the patient on high flow O2, 15L via NRB, established an IV, and checked his blood sugar, which was 22. I did not think that the patient would be able to chew glucose tablets because of his orientation, so I gave the patient 50mg of D50 IVP. Within 5

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minutes he started to recuperate, his orientation returned to normal at x4, person, place, time and event and his vitals also returned within normal limits.

Diabetes is a disease in which a person's "pancreas produces little or no insulin, a hormone that helps the body's tissues absorb glucose (sugar) so it can be used as a source of energy." ("Diabetes Mellitus" 1) The diagnosis of diabetes is divided into two classifications. Type 1, "formerly called insulin-dependent diabetes [...is when] the body

does not produce [or produces insufficient amounts of] insulin" ("Diabetes Mellitus" 1). The normal course of treatment for Type 1 diabetes is an insulin injection taken on a daily basis to balance the deficient insulin quantity being produced by the pancreas. The second class of diabetes is Type 2, formerly known as "non-insulin-dependent diabetes" (Emergency Care and Transportation of the Sick and Injured 405), which is when the body generates restricted amounts of insulin. In most cases, the body generates normal amounts of insulin, however it does not properly compensate for an individual's food intake or physical activity. Easers to treat than Type 1, the ways to care for and control Type 2 are through constant monitoring of an individual's diet and regular exercise. Through this monitoring and exercise it helps the body to maintain a balance of its glucose and insulin levels.

Diabetes is a disease that is wide spread and thus well known. In fact, statistics show that "[t]here are over 17 million people or 6.2% of the population in the United States who have diabetes" ("Impact of Diabetes" 1). Without proper intervention or treatment, both Type 1 and Type 2 diabetes can develop into severe and even life-threatening problems. These problems include, but are not limited to, permanent blindness, kidney disease, strokes, heart disease, problems with the nervous system, and difficulties with pregnancy. Because of the imbalance of glucose and insulin in the blood

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stream, "[d]iabetes can cause tiny blood vessels to become blocked; when this happens in the eye, it can result in Retinopathy (the breakdown of the lining at the back of the eye), causing blindness [....and w]hen diabetes affects the kidneys it is called Nephropathy (the inability of the kidney to properly filter body toxins)" ("Diabetes