Diabetic in the public

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Specializes in Transplant, homecare, hospice.

Again, at the CPR class...Okay...here's another scenerio, something I disagreed with again. Shame one me....Remind me to never take a medical class from anyone else other than a medically trained professional. Ok here goes....what would you do...??

You are in the grocery store and a 28 year old female collapses to the floor. She responds to you when you talk to her, but she is not lucid and she stares off. She is lethargic and is acting drunk. She tells you that she is a diabetic. She doesn't tell you anything else.

Do you rush to the candy isle seeking SUGAR? Or do you ask her if she took her insulin today? Is there a possibility that she may be HYPERglycemic versus HYPOgyclemic? Maybe she didn't take her insulin and she ate something thinking she would be home in enough time to get her insulin....but the store was busier than she thought and she was held up longer....

Am I wrong? Lol...maybe...My simple...very simple answer was, "ASK" the person if they are conscious if they are diabetic for one, and second, ask if they took their insulin recently.

The typical non-medical person isn't going to know the difference between hyper or hypoglycemia. I'm reluctant to shove candy in someone's mouth if they are already hyperglycemic....

I don't think the intructor liked me very much. :chuckle :p :rolleyes:

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Specializes in LTC.

Hee hee...that poor instructor! :chuckle

Just my humble opinion, but HYPOglycemia, IN GENERAL mind you, is more dangerous than HYPER...I've seen people do ok in the 500's, but seen them drooling and babbling incoherently when they've been in the 60's; I think I'd err on the side of spiking them even higher and get some sugar into them. Of course, it's a supermarket, so maybe you would be able to get ahold of a glucometer...I'm kidding on that one, yeeesh, talk about opening up a Good Samaritan can of worms.

It's a very interesting question, though...I have an uncle in his 70's who is NIDDM and he was telling me on Thanksgiving that lately his symptoms present very similarly whether he's high or low...i.e. lately, he gets the shakes, diaphoresis, confusion, lethargy, and he'll check his BS an it'll be in the 300's!!!!

I'd've loved to have been a fly on the wall during your class, LOL.

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I wouldn't shove candy into a person's mouth if that person was lethargic...airway, people, airway! She goes unresponsive and there you have it, obstructed airway. Never mind that you don't know if she's hyper/hypoglycemic. I'd stay with her, get someone to call 911, check for a medical ID card/bracelet, yada, yada, yada.

Why, oh why, did you take your course from RC! I read your other post...there's a reason why most facilities won't accept RC for BLS. I don't understand why they're allowed to teach.

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Specializes in LTC.

Excellent point, SJ....how easy it is for me to forget the simple ABC thing when I'm reading hypothetical stuff on a screen. :uhoh3:

Thanks for the reminder!

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Specializes in Med-Surg, Wound Care.

This sounds like a first aid course more than a CPR course. The Red Cross has been teaching first aid for years.

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Excellent point, SJ....how easy it is for me to forget the simple ABC thing when I'm reading hypothetical stuff on a screen. :uhoh3:

Thanks for the reminder!

LOL!

Can you tell I just had to renew ACLS? :chuckle

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This sounds like a first aid course more than a CPR course. The Red Cross has been teaching first aid for years.

It sounds like BLS, not just CPR. Maybe there's some first aid, too (like how to handle wounds, etc.) It could be that the OP just had an incompetent instructor, but I know for a fact the the hospitals in my area will not accept RC as valid for CPR. Has to come from AHA.

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I took BLS for healthcare providers through AHA (required by my school). We never had any seizure or diabetic questions we just did infant, child, adult CPR and first aid and s/s for stroke and MI. Should things like diabetes and seizures have been included in BLS?

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Specializes in LTC.

LOL SJ!!! I think mine expires in January, so this is good review for me. :rotfl:

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Specializes in Neuro, Acute, Geriatrics, Rehab, Oncology.

In my humble opinion as a nurse and a wife of an insulin dependant diabetic: When in doubt assume HYPOglycemia in an emergent sitation.If they rouse then you picked the right course, if not you are no worse off. There is no need in a grocery aisle to use candy ,use the squeeze frosting that is alot like the consistency of the tubes of stuff my hunny keeps on hand.

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Speaking as a diabetic nurse/EMT, you would have someone else call 911 immediately.

Theoretically, insulin shock (hyPOglycemia) is the greater worry here. It's more common, it has a more rapid onset, and much higher likelihood of a dire outcome. Besides, the kind of symptoms you're talking about wouldn't come from hyperglycemia unless the numbers were 500+ and that's not going to happen from eating a meal and skipping a dose of insulin. We're talking someone who is undiagnosed or majorly, majorly non-compliant.

Before our EMS system allowed blood glucose monitoring, we were taught to always err on the side of hyPO rather than hyPER. We gave buccal (inside the cheek) Glutose (glucose gel), O2, and transported rapidly.

Now we can monitor blood glucose and treat accordingly. EMT-Intermediates can start d50w IVs. The rest can call for an intercept. It's amazing how quickly hypoglycemic patients can come around. If we're still in the home, many of them refuse transport and we don't hear from them again for months.

Practially speaking, if you were in the above situation, if the person is capable of swallowing, you could give them juice, candy or something else that is sweet. Don't give a diet product that has aspartame instead of sugar. If they're out cold, put them on their side (recovery position) so they don't aspirate drool or vomit and just wait it out. In most urban areas, medical help can be on the scene in a couple of minutes.

If it's going to be longer than that, the 911 operator might be able to give you some suggestions. As a last resort, if you are in a grocery store, you could rub some of that frosting that comes in a tube on the inside of the cheek. Just make sure that the person is positioned so they won't choke.

Severe hypoglycemia is life threatening and rapid. Severe hyperglycemia is also life threatening but at a much slower pace. Giving glucose or sugar won't cause that much more harm to someone whose numbers are our-of-control high, but it may save the life of someone whose numbers are scarily low. Hope this helps.

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True, cake frosting might help if the pt can't swallow, but give a lethargic person a piece of candy? No way.

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