Diabetic Emergencies
Jennifer Burgess, Registered Nurse
Nurse-Led Outreach Team
Objectives
What is diabetes?
What is hypoglycemia?
What is hyperglycemia?
What do I do in a diabetic emergency?
How do we avoid one?
Where can I go for help?
What is diabetes?
Type 1: IDDM (Not preventable)
the pancreas does not produce insulin
glucose builds up in your blood instead of
being used for energy.
Type 2: NIDDM (Preventable)
Your body either:
Cannot produce enough insulin OR
Does not use the insulin it makes properly
What causes type 2 diabetes?
Age 40 or greater
Being overweight
Having a family member who has diabetes
Having had diabetes during pregnancy
Recommended Blood Sugar Targets
Normal Range
A1C: ≤6.0%
4.0-6.0 mmol/L fasting (before meals)
5.0-8.0 mmol/L two hours after eating
Most People with Diabetes
AIC: ≤7.0%
4.0-7.0 mmol/L fasting (before meals)
5.0-10.0 mmol/L two hours after eating
*Some residents will feel most comfortable at higher
ranges than this. Glucose control goals need to be
discussed with the Primary Care Practitioner*
What is Insulin?
A hormone produced by your body
Resident’s body may not have enough
If they need to take insulin they will find that it
makes them feel better and gives them the
energy they need.
Encourage them: Don’t be afraid of the
injections. Most diabetics say it is much easier
than expected.
What are Carbs?
One of our main sources of calories.
Sugars naturally found in honey, fruits, veggies
and milk
Refined sugars such as table sugar or sugars
added to candies, jams and soft drinks
Starches such as grains, rice, potatoes, corn
and legumes
All forms of carbohydrate are broken down into
glucose during digestion.
15 g Carbohydrates
7 soda crackers
1 slice bread
2 digestive cookies
4 social tea biscuits
¾ cup or 1 individual box of cereal
Given with a source of protein
Proteins
Peanut butter (15mL)
Cheese (1oz)
1 Egg
250mL milk
Free fluids
Fluids that do not contain carbohydrate
and therefore do not increase the blood
sugar.
(e.g. water, diet pop)
Avoiding Emergencies: Low Blood
Glucose (Sugar)
Caused by:
More physical activity than usual
Not eating on time *snacks are important!*
Eating less than you should have
Taking too much medication
The effects of drinking alcohol
This can happen quickly.
Hypo (low) Glycemia (sugar)
They may feel:
Shaky, light-headed
Confused
Hungry
Increased heart rate
Sweaty, headache
Weak
Numbness or tingling in their tongue or lips
Not all residents will have these symptoms.
What do I do for low blood sugar?
Are they conscious?
Can they swallow?
Check ABC’s and follow CPR directives for
that person.
Follow the appropriate clinical algorithm
Hyper (high) Glycemia (sugar)
Caused by:
ACTIVITIES
FOOD
MEDICATIONS
Food, activity and medications are not
balanced.
May happen when they are sick or under stress
CBG value of >20 mmol/L.
Early signs of hyperglycemia
Increased thirst
Headaches
Difficulty concentrating
Blurred vision
Frequent urination
Fatigue (weak, tired feeling)
Weight loss
Plan
Confirm CBG >20 mmol/L
Notify practitioner to obtain stat PRN CBG orders
and further direction
Corrective insulin dose
IV NaCl
Administer insulin according to practitioner’s
orders
If resident is able to swallow safely and has clear
or full fluids as part of their diet, encourage free
fluid intake
Ongoing assessment: BP, pulse, resp, O2 sat
Follow up with practitioner and monitor resident
until hyperglycemia is resolved.
Diabetic Ketoacidosis (DKA)
Acute and severe complication
Result of high levels of blood glucose and
ketones
Associated with poor control of diabetes or
as a complication of other illnesses.
Can be life threatening, requires
emergency treatment
Signs of DKA
Fruity odour on the breath
Shortness of breath
Confusion
Nausea and/or vomiting
Weight loss
Transfer to hospital.
Hyperglycemia
Includes assessment of:
Glycemic control (how have sugars been over
time?), include A1C
Meals and snacks
Medications
Monitoring
Physical activity
Routine follow up
Educational needs
When a resident is sick
Test blood glucose every 2-4 hours –
obtain a physician’s order to do so.
Continue to administer diabetes
medication
Many cold remedies and cough syrups
contain sugar – try to pick sugar free
products. The pharmacist can help you
make a good choice.
When a resident are sick
Encourage plenty of extra sugar-free fluids or
water
Replace solid food with fluids that have sugar if
they can’t eat as usual
They should try to consume 10g of carbohydrate every
hour
Call the practitioner if they vomit more than twice
in 12 hours
Continue to give their insulin, if the take insulin.
They might need to be given more than usual
depending on their blood sugar levels.
Teaching points for seniors
Be prepared
Report your diabetes to the motor vehicle
licensing office
Be aware of the changes to your insurance
Your province or territory may subsidize
the cost of blood glucose monitoring
supplies.
Support
Doctor
Nurse Practitioner
Nurse
Pharmacist
Dietitian
Social Worker
Psychologist
Foot care specialist
Endocrinologist
Opthamologist
The Canadian
Diabetes Association:
1-800-BANTING
(1-800-226-8464)
www.diabetes.ca
info@diabetes.ca
Questions?
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