Insulin Physiology
The hormone secreted by the pancreas that lowers blood glucose
What is Insulin
Under BCEHS, this is the IV Dextrose concentration used for adult hypoglycemia
10% dextrose
"Fruity" breath + Kussmaul respirations + dehydration - suggests this serious diabetic complication
DKA (diabetic ketoacidosis)
Before treating a suspected diabetic emergency, paramedics should always confirm this critical measurement
Blood glucose level (BGL)
Glycogenesis
Synthesis of glycogen from glucose, primarily for storage
The type of pancreatic cells that produce insulin
What is beta cells (you beta have insulin ;)
Aproximate dose range of D10W (in grams of dextrose) recommended for confirmed hypoglycemia
10-25g (ie:100-250ml of D10W)
Blood glucose under this value in (mmol/L) defines hypoglycemia per BCEHS guidelines
4 mmol/L
If a hyperglycemic patient shows signs of DKA or HHS, EMS should do this as soon as possible
Urgent transport/conveyance
Glyconeogenesis
Is the creation of glucose from a non-carbohydrate source like amino acids and lactate
When insulin is missing or ineffective, cells can take in this for energy
Glucose
Why must paramedics be cautious of extravasation when administering IV dextrose solution
risk of tissue necrosis
A hyperglycemic state common in Type 2 diabetes, with extreme glucose and severe dehydration but minimal ketosis
HHS (hyperosmolar hyperglycemic state)
If a patients blood glucose is corrected but they remain obtunded or have other issues, paramedics should do this
Assess for alternate causes/other pathologies
AEIOU TIPS!!!
Glycogen
Where the liver store excess glucose as glycogen
This is the diabetes type often caused by autoimmune destruction of beta cells
Type 1 diabetes
Intranasal glucagon
A hypoglycemic patient who is conscious and able to swallow should receive this per BCEHS first.
Oral glucose
Long-term high blood glucose can damage small vessels in this organ- leading to diabetic retinopathy
Eyes (retina/vessels)
Glycogenolysis
Glycogen degeneration
This happens in the liver and kidneys to produce glucose for balancing the blood sugar
The hormone that raises blood glucose, often acting opposite to insulin
Glucagon
What is the dose of IN glucagon
3mg q 15 mins
A dangerous effect common during treatment of DKA/HHS: rapid shifts can cause this- often via electrolyte or volume changes
Hypokalemia/dehydration/arrhythmia/cerebral edema
Name TWO non-glucose factors (besides high BG) that might trigger DKA- useful when taking a patient history
Stress, illness, dehydration, trauma
The 3 p's often the initial warning signs of diabetes
Polydipsia- excessive thirst
Polyphagia- extreme hunger that does not go away after eating
Polyuria- Frequent and excessive urination