April 27, 2010
One of the primary rules when dealing with first aid emergencies is “when in doubt call for help”. On land or at sea, if you are not sure of the severity of the emergency, call for help. One of the more common is the diabetic emergency.
The World Health Organization (WHO) defines diabetes as a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.
Diabetes facts (from The World Health Organization): • More than 220 million people worldwide have diabetes. • In 2005, an estimated 1.1 million people died from diabetes. • Almost 80 percent of diabetes deaths occur in low- and middle-income countries. • Almost half of diabetes deaths occur in people under the age of 70 years. • 55 percent of diabetes deaths are in women. • WHO projects that diabetes deaths will double between 2005 and 2030. • Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use can prevent or delay the onset of diabetes.
Type 1 diabetes (previously known as insulin-dependent, juvenile, brittle or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin. Symptoms include excessive urination, excessive thirst, constant hunger, weight loss, vision changes, extreme fatigue and irritability. These symptoms may appear suddenly.
Type 2 diabetes (formerly called non-insulin-dependent or adult-onset) results from the body’s ineffective use of insulin. Type 2 diabetes comprises 90 percent of people with diabetes around the world, and is largely the result of poor diet and physical inactivity.
If the person is aware of their condition they may be able to tell you what is wrong and how you can assist them. However, they may be unaware of the disease or symptoms may have progressed to the point of confusion. Some signs and symptoms may include dizziness, drowsiness, rapid breathing, lack of coordination, rapid pulse, sweating but the skin is cold to the touch, weakness, shaking, headache, irritability, bizarre or combative behavior, nervousness and they may have a fruity odor to their breath.
Symptoms may be similar to those of Type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen. Until recently, this type of diabetes was seen only in adults but it is now also occurring in children.
If you know that a person is diabetic and he or she is experiencing symptoms and they are conscious, give them something to eat or drink that contains plenty of simple sugar, such as candy, fruit juice, honey or non-diet soda. If the person is suffering from low blood sugar, or hypoglycemia, the sugar will help within minutes. If the person is feeling ill because of high blood sugar, or hyperglycemia, he or she will not be harmed by the extra sugar but you must make arrangements to get them to professional medical care as soon as possible. In the case of untreated hyper or hypoglycemia, permanent impairment, coma and death can occur.
If the person is unconscious, place them into the recovery position, on their side and monitor their breathing (ABCs) and call for help. The doctor will most likely instruct you to obtain a complete set of vitals, including measuring their blood glucose level using a glucometer. The doctor may then advise you to administer glucagon. It is used when seizures occur in an insulin user who is unable at that point to help themselves or if they become unconscious. Glucagon will facilitate the release of stored glucose back into the bloodstream, thus rapidly raising blood glucose levels.
Rebecca Castellano with Ocean Medical International states "all of our medical kits provide treatment for low blood sugar (hypoglycemia) such as instant glucose and injectable glucagon in cases of severe diabetic hypoglycemia. Glucose blood testing equipment (glucometer) while not standard, can be added to any kit by request. Minimal training is required to learn to use these devices.”
During the past few years we have seen earthquakes, floods, hurricanes, snow storms, tornados, tsunamis and many other natural disasters. Because these disasters can make it difficult to get medication and medical attention, the American Diabetes Association recommends having three days worth of diabetic supplies, which, depending on how you take care of your diabetes, could include oral medication, insulin, insulin delivery supplies, lancets, extra batteries for your meter and/or pump, and a quick-acting source of glucose.
Glucagon and many insulins require refrigeration so cold gel packs and coolers should be ready in case of power outage. They also suggest having an extra glucagon emergency kit. These recommendations are for people on dry land. For those who make their living on the water you may need to revise the three days worth to fit your boats schedule. Remember, there is no such thing as too prepared.
You should keep all of your personal medications in an easy-to-identify container, and store it in a location that is easy to get to in an emergency. Be certain to share this information with your crew should they need to retrieve it for you.
If you have diabetic passengers or crew onboard, please take the time to review what diabetic supplies you have in your medical kit and their intended uses. Periodically remind everyone how to use glucagon and keep all medicines and supplies in date.
Although the purpose of this article is how to treat diabetic emergencies I feel it important to mention how we can prevent or delay the onset of type 2 diabetes. The steps to preventing type 2 diabetes and its complications include achieving and maintaining a healthy body weight, being physically active – exercising 30 minutes every day, and eating a healthy balanced diet with minimal processed foods and sugars.
If you would like to learn more about diabetes both the American Diabetes Association and The World Health Organization are excellent sources for information.
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