when we hear about type I diabetes emergency situations, as a nurse, we automatically visualize a person feeling weak, tachycardia, and dizzy, typical signs of hypoglycemia. We also know that a diabetic person should carry a candy.
But these only apply to those who are on insulin medication, right? If a person has all the signs of diabetes (polyuria, thirst, etc) but is not on insulin regimen (not yet diagnosed because socioeconomic reason, for example), there is no risk of hypoglycemia, right?
If I am right, that means, when we talk about type I diabetes' hypoglycemia emergency, we are watching the medication side effect, not the disease.
If a type 1 takes their insulin and then gets a stomach flu and vomits their meal, they could become hypoglycemic. If for some reason they miss a meal they could become hypoglycemic because their long-acting insulin is kicking in.
If they are over-active for some reason and don't eat enough or take in enough carbs to compensate they could become hypoglycemic.
Surgery/infections can put additional stress on the body and result in a low blood sugar.
I've seen all these happen.
They could only become hypoglycemic if they have basal insulin on board. In 8 years of managing my children's type 1 diabetes, the only time we've ever seen hypo's when sick was when they had a lot of basal on board and were throwing up so much that they couldn't keep anything down. Most illnesses cause high blood sugars, and in some kids blood sugars trending upwards are the first signs of an approaching illness.
The OP's question was a situation where the patient was taking no insulin at all, so that's different. No insulin at all means blood sugars will start rising. Even if you don't eat any carbs at all, your body still needs basal insulin to function.
People with just low BSLs (blood sugar levels) can have hypo attacks, my gf is one of them.
This can apply to anyone, ie: when people are ill, not eating or having enough fluids for example.
Whoever is giving you the info in your post is giving you incorrect advice.
All people who look like they're have a hypo attack treat the same way, as u don't know if they have diabetes or not. Hyper & hypo S&S can be very similar, so call an ambulance/call for help, give sugar in the form of a sweet drink/sweet biscuit or something similar (not hard, sweet lollies as people can choke on them) and stay till help arrives. If in a hospital setting follow your protocol and notify MD immediately re patient's condition. Always follow your emergency protocols & always alert other staff first if a pt looks like they're going hypo or hyper. Never leave a pt on their own in this situation.
No one could really be having a hypoglcaemic episode unless they are taking a sulfonylurea or injecting insulin or have a pancreatic tumour.
You can of course have low blood glucose levels and feel light headed and dizzy, but as the book says according to WHO in
Australian terms of mmol per litre a hypoglycaemic episode is classed as 3.5mmol/L and below.
The liver stores glucogen and releases glucose and therefore stops hypoglcaemia in us that do not take blood glucose lowering agents such as mentioned above.
People with diabetes are educated to take on first sign of hypoglycemia. trembling, numbness of extremeties, mouth, sweating, moving on to lack of concentration take BGL and if below 4 to take 15g of fast acting carbohydrate, usually jelly beans are the sweets used in education wait 5 minutes take BGL and if not increased take 15g of fast acting CHO again, then when raised above 4 take a low glycaemic food such as cheese/biscuits, sandwhich...etc etc.
Call an ambulance/seek medical attention if person with the hypo requires much assistance/cannot take anything oral, requires glucagon injection.
same treatment for people with type 1 or type 2- insulin requiring. Type 2 taking meformin only, do/should not have hypos as metformin does not increase insulin secretion...but there has been the odd reporting of such.
Hyperglycaemia on the other hand is usually easy to spot. Clients complain of polydipsia, polyuria, blurred vision, flushed, complete exhaustion andor fidgets and most times talks incessantly about nothing, I have found.
People with type 1 diabetes can have the 'fruity' breath (DKA) as well and once smelt? one never forgets. This is when ketones are present and can be within minutes become a medical emergency-call an ambulance/seek medical help urgently. This is caused by lack of insulin either injected or not being produced by the pancreas.
Thank you so much for replies. I am relieved to see that I wasn't the only one who weren't sure about this. people automatically think of hypglycemic symptoms when they think of diabetes, but with noncompliance, we also need to be aware of hyperglycemic symptoms.
84RN
97 Posts
They could only become hypoglycemic if they have basal insulin on board. In 8 years of managing my children's type 1 diabetes, the only time we've ever seen hypo's when sick was when they had a lot of basal on board and were throwing up so much that they couldn't keep anything down. Most illnesses cause high blood sugars, and in some kids blood sugars trending upwards are the first signs of an approaching illness.
The OP's question was a situation where the patient was taking no insulin at all, so that's different. No insulin at all means blood sugars will start rising. Even if you don't eat any carbs at all, your body still needs basal insulin to function.