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Diabetic in the public

Specializes in Transplant, homecare, hospice. Has 9 years experience.

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:

Simba&NalasMom, LPN

Has 14 years experience.

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.

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.

Simba&NalasMom, LPN

Has 14 years experience.

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!

lsyorke, RN

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.

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

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.

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?

Simba&NalasMom, LPN

Has 14 years experience.

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

yvonnemuse, BSN, RN

Specializes in Neuro, Acute, Geriatrics, Rehab, Oncology. Has 16 years experience.

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.

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.

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

HappyJaxRN

Specializes in Transplant, homecare, hospice. Has 9 years experience.

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.

LOL....um, it was something straight out of Jerry Springer.:p I think the lady had it in for me. I was really quiet until she mentioned the part about the hyperglycemia and I asked a simple question. I really shouldn't have said anything. Ooops. Live and learn. :chuckle

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.

I agree with this . . . . assuming hypo is the better idea . . . . people can tolerate hyper much better. And using frosting is a great idea or honey. Of course you should never shove something a person can choke on into their mouths.

steph

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.

Isn't Karo syrup very concentrated sugar as well? Wouldn't it take a small amount to do the trick?

Isn't Karo syrup very concentrated sugar as well? Wouldn't it take a small amount to do the trick?

It is but it's also--to use a highly technical term--gloopy. Glutose gel stays where it's put and, although I've never actually used tubed frosting, I would imagine that it behaves similarly. The advantage here is that if there are problems with vomiting or choking, you can actually reach in and wipe the substance off so it doesn't make things worse.

Another thing that you can do is check the purse or pockets (with a witness observing) for a glucagon kit. If you know how to use it, this too, can be life-saving and there are a number of type I's who carry such a kit the way people with allergies carry epi-pens. Even if you aren't familiar with it, a trained dispatcher might be able to talk you through it. The injection isn't complicated. The hardest part is mixing the powder with the the diluent and making sure it is completely absorbed. EMS personnel should carry these as well.

Simba&NalasMom, LPN

Has 14 years experience.

Forgive me if this sounds ignorant, but I learned in school that honey is actually low on the glycemic index even though it's a monosaccharide, so my instructor advised against using it.

Simba&NalasMom, LPN

Has 14 years experience.

Too funny. My BLS was done by the AHA and my instructor was hysterical! When I had to practice on the defib, the other students were practicing touching the victim and I started to yell at them to stand back and the instructor rolled her eyes and said (in her Texas accent) "Hey, man, I said large and in charge; not big and a b****!" :rotfl:

Just what I was going to say yvonnemuse. Get the frosting tube. A relative of mine is diabetic and thats how they get.

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