13. Diabetic Problems - ACD

Question 1

Problem Suffix

Answer 1

C: Combative or aggressive

Question 2

Coma

Answer 2

State of unconsciousness from which patient cannot be aroused

Question 3

Rule 1

Answer 3

Determining the level of consciousness is the key to correctly assigning the prehospital response. A complaint of abnormal blood sugar level alone does not constitute a pre-arrival emergency.

Question 4

Rule 2

Answer 4

The complaint of blood sugar level abnormality (w/o priority symptoms) should be coded as 13-A-1

Question 5

Rule 3

Answer 5

EMDs should not advise the administration of oral sugar to symptomatic diabetics. There is no clinical evidence of improved outcomes by such EMD intervention, while the potential for airway aspiration in the not alert patient is high.

Question 6

Rule 4

Answer 6

Airway of an unconscious patient must be constantly maintained

Question 7

Rule 5

Answer 7

If caller asks whether the patient should be given their medication now, the EMD should only give instructions included in the protocol

Question 8

Axiom 1

Answer 8

Diabetics is a “diagnosis” that EMDs may accept at face value because of its high degree of accuracy

Question 9

Axiom 2

Answer 9

A significant potential for error is to confuse alcohol or drug intoxication with low blood sugar from too much insulin (insulin shock)

Question 10

Axiom 3

Answer 10

An early sign of low blood sugar is abnormal behaviour (a decreasing level of consciousness), which may include agitation, aggressiveness, impaired judgment, confusion, and/or combativeness

Question 11

Hypoglycemia/Insulin Shock (rapid onset)

Answer 11

Too much insulin has depleted the body’s available blood sugar. Since the brain’s most usable fuel is sugar, it is the first organ at risk. This is more serious if the patient is not alert, and is commonly confused with alcohol intoxication.

Question 12

Diabetic Ketoacidosis (gradual onset)

Answer 12

Pre-coma state resulting from insufficient insulin. Unable to use sugar as fuel, the body burns its own tissue (fat, muscle). The ketoacids (acetones) produced are “Toxic” to the patient and cause a slowly increasing illness state. This is not considered a prehospital medical emergency if the patient is alert but requires medical evaluation and treatment.

Question 13

Diabetic Coma (later onset)

Answer 13

Unconsciousness or decreased level of consciousness occurring later in untreated diabetic ketoacidosis. Without an accurate history, this problem may be difficult to tell from insulin shock. Airay control and constant monitoring are the first priority in the unconscious patient with confirmed effective breathing.