DIABETIC

EMERGENCIES
GROUP 10

UBANA, CARL
VERSOZA, ANJELICA
VILLAFLORES, KAREN
VIVAR, JEREMIAH
DEFINITION

>Diabetes mellitus is a condition in which the
pancreas no longer produces enough insulin
or cells stop responding to the insulin that is
produced, so that glucose in the blood cannot
be absorbed into the cells of the body.

> It is a chronic disease that causes serious
health complications including renal (kidney)
failure, heart disease, stroke, and blindness.
> It occurs because of the high level of sugars in
the blood.
CLASSIFICATIONS
Type I diabetes, sometimes called juvenile
diabetes, begins most commonly in childhood
or adolescence. In this form of diabetes, the
body produces little or no insulin. This form
also is called insulin-dependent diabetes
because people who develop this type need to
have daily injections of insulin.

Type II, more common type. Sometimes called
age-onset or adult-onset diabetes, this form
of diabetes occurs most often in people who
are overweight and who do not exercise. Type
II is considered a milder form of diabetes
because of its slow onset and because it
usually can be controlled with diet and oral
medication.
Gestational diabetes can develop during
pregnancy and generally resolves after the
baby is delivered. This diabetic condition
develops during the second or third trimester
of pregnancy in about 2% of pregnancies.
Children of women with gestational diabetes
are more likely to be born prematurely, have
hypoglycemia, or have severe jaundice at
birth.

DIABETIC COMPLICATIONS
Hypoglycemia is a medical emergeny that involves an
abnormally diminished content of glucose in the blood.
Diabetic ketoacidosis is a potentially life-threatening
complication in patients with diabetes mellitus. It happens
predominantly in those with type 1 diabetes. It results from a
shortage of insulin; in response the body switches to
burning fatty acids and producing acidic ketone bodies.
Hyperosmolar coma is a complication of diabetes
mellitus usually in type 2 in which high blood sugars cause
severe dehydration, increases in osmolarity (relative
concentration of solute) and a high risk of
complications, coma and death.
Signs and symptoms
If not treated quickly enough,
fluctuations in blood glucose levels
can lead to a person with diabetes
becoming unwell and losing
consciousness. The two conditions
associated with diabetes are:
hyperglycaemia - high blood
glucose
hypoglycaemia - low blood
glucose.
Signs and symptoms of hypoglycaemia
and hyperglycaemia in type 1 diabetes
Hypoglycaemia (low blood sugar)
- Hypoglycaemia occurs when any insulin in the
body has moved too much glucose out of the
bloodstream and blood glucose levels have become
very low. This is usually because the patient has taken
too much insulin, exercised too vigorously or consumed
alcohol on an empty stomach.
Usually hypoglycaemia can be corrected simply
by eating or drinking something with a high
glucose content. Symptoms of hypoglycemia
include cold and clammy skin, confusion, poor
balance, feeling faint and rapid heartbeat.

Glucagon -an emergency injection of
a hormone called to raise the level of
glucose in their blood.

Some people with diabetes are at
particular risk of hypoglycaemia:
those who frequently experience
hypoglycaemia, even if they are able to
treat themselves
people who have poor awareness of
hypoglycaemia symptoms
people who fast (e.g. during Ramadan)
those who vary their eating or exercise
patterns
older people, particularly those in the
early stages of dementia
people with poor mental health
people with a learning disability
people with alcohol-related
health problems
people with poor injection
technique
people not using glucose
lowering therapies correctly
(e.g. dose or timing)
women who are pregnant or
breastfeeding.

Hyperglycaemia (high blood
glucose)
Hyperglycaemia occurs when the body cannot
produce any, or enough, insulin to regulate
blood glucose. Consequently blood glucose
levels become too high. This happens when
there is no insulin to move glucose out of the
bloodstream and into the cells to produce
energy. The symptoms of hyperglycaemia are
similar to the main symptoms of diabetes but
they can come on suddenly and severely. If left
untreated, hyperglycaemia can lead to diabetic
ketoacidosis (DKA), which can eventually cause
unconsciousness and even death.
hypoglycaemia and hyperglycaemia in type
2 diabetes
Hypoglycaemia (low blood glucose)
- Severe hypoglycemia is also very rare among
people with type 2 diabetes who are taking blood
glucose lowering medications such as metformin
(Glucophage). However people with type 2
diabetes who take medications that increase the
amount of insulin released from the pancreas can
be at risk of low blood glucose levels. These
medications include Gliclazide, Glipizide and
Glimpiride. Hypoglycemia also can happen in
people with type 2 diabetes who use insulin.
Hyperglycaemia (high blood glucose)
Type 2 diabetes develops because the body either
can not produce enough insulin or because the
cells in the body do not respond properly to
insulin. Consequently, blood glucose levels
become too high. This happens when there is no
insulin available to move glucose out of the
bloodstream and into the cells to produce
energy. People with type 2 diabetes are
extremely unlikely to develop diabetic
ketoacidosis (DKA) and are more likely to develop
Hyperosmolar Hyperglycaemic State or HHS. Like
DKA, this condition is also life threatening with a
high mortality rate.
Diabetic ketoacidosis (DKA)
DKA is a life threatening complication in
people with untreated diabetes or
improperly/difficult to managed
diabetes. It is most common in type 1
diabetes but it can also occur in type 2.
The difference between hyperglycaemia
and DKA relates to the level of ketones
and dehydration.
DKA can also occur in people with
diabetes who have an overwhelming
infection or in people who have
misadministered their insulin doses.
The signs and symptoms of DKA include:
feeling sluggish progressing to extreme
tiredness
fruity smell to breath (similar to the smell
of nail polish remover)
extreme thirst, despite large fluid intake
constant urination (may include bedwetting)
extreme weight loss
oral thrush or yeast infections that won't
resolve
muscle wasting
vomiting - this is a late sign and at this point,
DKA is life threatening and medical attention
should be sought immediately.

Hyperosmolar Hyperglycemic
Nonketotic Syndrome
Hyperosmolar hyperglycemic nonketotic
syndrome usually occurs after the diabetic
has experienced and even recovered from
infection, or has experienced unusual
stress. Infections and stress cause the
blood sugar levels in the body to rise to
very high levels, and as a result, the body
tries desperately to rid itself of this excess
sugar. The body does this by producing
large amounts of urine.
According to the Mayo Clinic, the
person will then urinate frequently
and lose excess body fluids leading
to dehydration, electrolyte
imbalances, coma and even death.
Symptoms of this emergency include
confusion, weakness on one side of
the body, increased or rapid heart
rate, fever and hallucinations.

References
Cryer PE, Davis SN, Shamoon H.
Hypoglycemia in diabetes. Diabetes
Care 2003;26:1902-1912.
Diabetic ketoacidosis. What it is and how
to prevent it. Am Fam
Physician.2005;71:1721.
McDermott MT. Endocrine Secrets.
4
th
ed. St. Louis, MO: Mosby. 2004.
http://www.rcn.org.uk/development/practic
e/cpd_online_learning/diabetes_essentials/
emergency_treatment
CAUSES
Type 1 Diabetes
Pancreas not secreting insulin at all.
Genetics

Not enough insulin
Insulin resistance

Type 2 Diabetes

Age (over 40)
Genetics
Obesity/Overweight

Diabetic emergencies are caused
by an imbalance between insulin
and sugar
TRIGGERED BY:

Missed meals
Accidental overdose of medications
Too much strenuous exercise
Cause of hypoglycemia ( low blood
glucose)
Change in physical activity(duration, timing)
Change in meals (portion, timing)
Alcohol on an empty stomach
Medication (aspirin, others for mental disorders)
Menstrual period
Insulin overdose
Ill timed
Excessive

Cause of hyperglycemia (high blood
glucose)
Not getting enough insulin
Eating more
Stress and illness
Medications (for sleep, decongestants, and
corticosteroids like prednisone)
Diabetic Ketoacidosis
Insulin deficiency
Increased of ketones
Illness- adrenaline,cortisol
Missed insulin theraphy
Surgery
Alcohol, drug abuse


Hyperosmolar Hyperglycemic
State(HHS)
Severe hyperglycemia
Medication
Illness such as infection, injury
Not drinking enough water
Poor kidney function
Poor management of diabetes


Management of Diabetes
Medications
Metformin First line treatment for type 2
diabetes
Regular intake of Insulin

Management
Keep blood sugar levels close to normal
(euglycemia)
This can be achieved through:
Exercise
Diet
Medications


Prevention of Diabetes
Prevention

Lose excess fat (Maintain a healthy weight)
Healthy diet (Skip the sugary drinks and food)
Exercise regularly
Do not smoke
Moderate alcohol intake (a drink a day for
women, and two drinks a day for men)