Tiêu đề Diabetes - Handbook 2024.pdf ✅

80 I NOLS WILDERNESS MEDICINE HANDBOOK I © 2024 NOLS DIABETES Diabetes is a complex disease of sugar metabolism, characterized by a broad array of physiological disturbances. The disturbance in sugar metabolism can manifest itself as too much or too little sugar in the blood. Normal blood sugar levels, which a person with diabetes can measure, range from 80–120 mg/dl (4.0-7.0 mmol/L). HYPERGLYCEMIA A complication of diabetes caused by too much sugar (hyperglycemia) and not enough insulin. Without insulin, sugar collects in the blood. The patient becomes dehydrated in an attempt to excrete the excess sugar via the kidneys. Since the body cannot process the sugar, it burns other fuels instead, causing a build up of harmful byprod- ucts in the bloodstream. Causes include: insufcient or damaged insulin, excessive food intake, lack of exercise, ill- ness or infection. Hyperglycemia appears more gradually than hypoglycemia. SIGNS AND SYMPTOMS • LOR: Over time, hyperglycemia can lead to an altered LOR • HR: weak, rapid • RR: increased • SCTM: warm, pink, dry • Increased hunger, increased thirst, increased urine output, fatigue • Breath odor: acetone, sweet • Persistent high blood sugar levels TREATMENT PRINCIPLES 1. Check the patient’s blood sugar. 2. If you are unable to distinguish between hypoglycemia and hyperglycemia, give sugar. 3. Hydrate. 4. As a care provider we do not calculate doses or administer insulin to a patient. A person with diabetes may adjust their insulin dosing in response to blood sugar levels, stress, or illness, and self-administer their medication. 5. Evacuate. HYPOGLYCEMIA Insulin facilitates movement of sugar into the cells. Hypoglycemia is a complication of diabetes caused when the person with insulin dependent diabetes takes too much insulin or fails to eat sufcient sugar to match the insulin level. The blood sugar level drops (hypoglycemia) and may be insufcient to maintain normal brain function. Diabetic hypoglycemia can happen quickly and requires immediate treatment. SIGNS AND SYMPTOMS • LOR: weak, disoriented, irritable, “not quite themselves;” progressing to obvious mental status changes, unresponsiveness, and seizures • HR: rapid • RR: normal or shallow • SCTM: pale, cool, clammy • BP: no changes or slightly elevated • Breath odor: no changes • Blood sugar less than 80mg/dl (4.0 mmol/L) TREATMENT PRINCIPLES 1. Check the patient’s blood sugar. 2. If you are unable to distinguish between hypoglycemia and hyperglycemia, give sugar. 3. Give sugar until the responsive patient regains adequate LOR. If the patient is unresponsive, place the patient on their side, rub sugar into their gums repeatedly. Protect the airway. 4. Once the patient responds to sugar, a more hearty snack or meal may be appropriate until blood sugar level stabilizes. 5. Rapidly evacuate any person with diabetes who has hypoglycemia that does not respond to treatment.