diabetes question

[unsaint77]

I just want to know if I understand it right....

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.

[Pepper The Cat, BSN, RN]

Anyone can have a hypoglycemic episode- even non-diabetics.

And, if I am understanding your question correctly, hypoglycemia in insulin dependent diabetics isn't necessarily a "side effect". It is usually a result of non enough intake, too much insulin or due to some other medical issue (flu, colds, surgery, etc) effecting the body.

[unsaint77]

Okay, a case example. This person (let's call him Bob) is type I diabetic, but he does not want to take any insulin. He throws the med away. He lives by himself. (Please Please Please, let's not talk about compliance issue. I just want to know about the diabetes and pathology part)

NOW, when I go see Bob once a month, do I still worry about hypoglycemic symptoms? Again, he does NOT take insulin. (I perfectly understand that he will be on the high risk of ketoacidosis and diabetic coma.)

[blondy2061h, MSN, RN]

Okay, a case example. This person (let's call him Bob) is type I diabetic, but he does not want to take any insulin. He throws the med away. He lives by himself. (Please Please Please, let's not talk about compliance issue. I just want to know about the diabetes and pathology part)

NOW, when I go see Bob once a month, do I still worry about hypoglycemic symptoms? Again, he does NOT take insulin. (I perfectly understand that he will be on the high risk of ketoacidosis and diabetic coma.)

No. Bob is at risk of dying from DKA though. Type 1s can last very shortly without insulin before becoming critically ill.

[Altra, BSN, RN]

OP, we cannot provide medical advice here at allnurses.com. You can encourage "Bob" to see his physician, and you can learn about diabetes, if you wish, using any number of quality online sources. Good luck to you.

Here's one source for you to browse:

http://ndep.nih.gov/

[rn/writer, RN]

Is Bob truly a Type 1 diabetic, or is he an insulin-dependent Tyoe 2? It used to be that Type 2s weren't given insulin, so anyone taking it was assumed to be a Type 1. Now, many Type 2s use insulin along with oral meds. That can be confusing.

If this guy is really a Type 1 and is refusing to take his insulin, he'll flirt with DKA until it finishes him off. But if he's Type 2, he could probably stumble and lurch from one mini-crisis to the next for years before he crashes and burns.

You said you see him once a month. Are you a home health nurse? Has he ever had any counseling about his disease and the emotions connected with it? This might be a good next step.

[leslie :-D]

Anyone can have a hypoglycemic episode- even non-diabetics.

i'm serious when i ask, how could a type I diabetic have a hypoglycemic event, if their pancreas doesn't produce insulin?

NOW, when I go see Bob once a month, do I still worry about hypoglycemic symptoms? Again, he does NOT take insulin. (I perfectly understand that he will be on the high risk of ketoacidosis and diabetic coma.)

unless i am overlooking some pertinent info, i can't see why you'd worry about hypoglycemia if he doesn't take insulin or any po agents.

leslie

[Pepper The Cat, BSN, RN]

i

'm serious when i ask, how could a type I diabetic have a hypoglycemic event, if their pancreas doesn't produce insulin?

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.

[leslie :-D]

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.

thanks pepper.

i know all this (re everything you've posted).

i was only asking about this person op was talking about, who doesn't/won't take insulin.

so all i was asking is, how can a type I diabetic become hypoglycemic if he doesn't take insulin?

and fwiw, stress/infections will increase blood sugar, and not lower it.:)

leslie

[Pepper The Cat, BSN, RN]

thanks pepper.i know all this (re everything you've posted).i was only asking about this person op was talking about, who doesn't/won't take insulin.so all i was asking is, how can a type I diabetic become hypoglycemic if he doesn't take insulin?and fwiw, stress/infections will increase blood sugar, and not lower it.:)leslie

Sorry Leslie. I thought you were challenging me! Which I found strange because I know we are usually on the same wave length!To get back to the OP, if he isn't taking his insulin, I'd be more worried about hyperglycemia and the damage being done by that.

[leslie :-D]

To get back to the OP, if he isn't taking his insulin, I'd be more worried about hyperglycemia and the damage being done by that.

totally agree.

not understanding why hypoglycemia would even be a concern.

much bigger fish to fry here.

(and absolute NOT challenging you.:cheers:)

leslie

[84RN]

I'm the parent of two type 1 diabetics, and my answer would be no, there would be no hypoglycemia in a type 1 diabetic (one that has had the disease for a long period of time) that has not been taking his insulin.

There are times when early in the diabetes process, the patient will have a "honeymoon" period, where shortly after dx, for some reason, their remaining beta cells start pumping out more insulin, sort of a last gasp before shutting down completely. During that time, the insulin needs may drop dramatically, and a few type 1's will even stop needing much or any insulin at all for a short period of time. This never lasts though, and within weeks to a couple of months, the remaining beta cells die and blood sugars will start rising, so insulin is needed again.

In the absence of insulin, blood sugars will continue to rise, so a type 1 without insulin is not at risk of hypoglycemia. Years ago before insulin was discovered, some patients lived for years by eliminating carbs from their diet and did live, but they basically wasted away because their bodies burned fat for energy. I'm not sure why those patients that lived didn't go into full blown DKA.