Cardiovascular medical emergencies

Lesson no. 2

Diabetes Mellitus

Diabetes is a chronic metabolic disease that impairs the patient’s ability to balance sugar levels in their blood. Diabetes is among the most common diseases in the Western world, and the percentage of people suffering from this disease has doubled over the last twenty years. By understanding the risk factors for the disease, we can understand how to avoid this phenomenon.

Uncontrollable Factors

  • Heredity
  • Viruses
  • Pregnancy
  • Defective immune system
  • Cancerous tumors

Controlled Factors

  • Distress, mental stress
  • A diet rich in simple sugars
  • Obesity

 

In an ordinary person who does not suffer from diabetes, sugars break down in the digestive system and are absorbed into the blood after a meal. Blood sugar is actively placed in the cells through a hormone called insulin secreted from the pancreas.

 

Juvenile Diabetes – Type I – (formerly IDDM) – is common in young people. It is most often an autoimmune condition (a reaction of the body’s immune system against itself) that causes the destruction of insulin-secreting pancreatic cells and eventually leads to complete insulin deficiency. Due to the lack of insulin that puts glucose into most of the body’s cells, these patients must inject artificial insulin into themselves (hence the name IDDM – Insulin Dependent Diabetes Mellitus).

Common Diabetes – Type II – (formerly NIDDM) is more common in adults. This is an acquired diabetes, which is closely linked to an unbalanced lifestyle (improper nutrition, lack of exercise), which has a strong genetic component. Expressed by increased resistance of the target cells to insulin, so the cells do not respond to insulin properly.

 

This diabetes can be treated with pills (the pills lower the resistance of the insulin target cells as insulin is still produced by the pancreas in the early stages of the disease). Insulin can also be used as treatment when the body’s response to the oral treatment has adjusted and as the condition increases in severity (NIDDM – Non-Insulin Dependent Diabetes Mellitus).

Diabetic Emergencies

Hypoglycemia

Low blood sugar below 60 mg/dl.

 

It is usually caused by overinjection of insulin, missed meals, extreme exercise, vomiting and diarrhea (more common in diabetics, of course).

 

Case Identification

 

  • A patient is known to be diabetic
  • Hunger
  • Sweat
  • Paleness
  • Change in level of consciousness (apathy/unconsciousness/agility)
  • Muscle tremors
  • Confusion
  • Rapid heartbeat
  • Quick breathing
  • Seizures
  • Dizziness, and of course low sugar

 

Treatment

 

  • If the patient is fully aware and describing the symptoms, he should be given bread (complex carbohydrates) with available sugar (jam, for example) in order to quickly raise long-term sugar levels
  • If the patient is semi-conscious, it is necessary to call an ambulance to provide oral/intravenous glucose and to follow the hotline’s instructions.

Hyperglycemia

High blood sugar above 120 mg/dl.

 

It is usually caused by a lack of insulin injection/misuse of drugs for diabetes, infection, disease or steroid treatment.

 

The body secretes the high amount of sugar in urine, which causes excessive urine which can cause dehydration!

 

Case Identification

The signs will usually be apparent when sugar levels rise above 300 mg/dl.

 

  • Slow decline (relative to hypoglycemia) of the level of consciousness
  • Excessive/frequent urination
  • The smell of acetone from the mouth
  • Abdominal pain
  • Thirst
  • Quick and superficial breaths
  • Fast heart rate, high blood sugar

 

Treatment

 

 When in the field, there is no treatment other than providing something to drink and preventing dehydration, as well as evacuation to the hospital. If the patient is unable to drink without vomiting, this should be noted to the medical team so that they can administer liquids venously.

 

Unbalanced diabetes over time can damage various organs.

 

The main target organs are:

 

  • Heart, blood vessels (increased risk of stroke)
  • Kidneys
  • Eyes
  • Neural injury that may lead to decreased sensation and limb injuries as a result.

did you know

Diabetes mellitus translates to “sweet urine” due to the fact that patients with the disease secrete a large amount of sugar in the urine. In the past, before the invention of today’s diabetes tests, doctors used to test by tasting the patient’s urine. Today, this form of testing is no longer practiced, but there is a whiskey manufacturer that produces whiskey from the urine of diabetics. In pets, diabetes is also becoming more common, especially in male cats and dogs. The causes and consequences are mostly similar to human diabetes and are due in part to heredity, diet and physical inactivity. One of the possible symptoms of diabetes is blindness or visual blur. The disease can increase glaucoma and cataract, but the most common problem is caused by blockage and swelling of the blood vessels in the eyes. In this process, the walls of the blood vessels become unusually thin until they can eventually leak. This will be seen by the appearance of dots in the visual landscape.

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