Diabetes: Sugar, Spice, and Not So Nice
What is the normal range for a non-fasting adult’s blood glucose level?
80-120 mg/dL (p. 507)
What type of cell becomes misshapen in sickle cell disease?
RBCs
What is the standard dose of glucagon for an adult with severe hypoglycemia?
1 mg
You perform a FAST stroke scale on your patient and the results are as follows: Equal smile, arms are weak bilaterally, speech is slurred, and LWK time was 2 hours prior. Before you call into the hospital to call for a stroke alert, what other information is vital to obtain?
A blood glucose reading!!!
Definition of tachypnea?
Increased respiratory rate
Name the 2 most key assessment findings that would help differentiate between hypoglycemia and hyperglycemia (besides their blood glucose levels)?
Skin color, temperature, condition: Hypoglycemia: pale, cool, diaphoretic. Hyperglycemia: warm, dry, flushed.
Respiratory rate: Hypoglycemia: normal to shallow. Hyperglycemia: rapid and deep (in DKA).
What are the 4 components of blood? for 5 extra points, what are the medical terminology names for each of the components?
RBC's (erythrocytes), WBC's (leukocytes), Plasma, and platelets (thrombocytes).
What routes can AEMT use to administer glucagon?
IM or IN
What is the most common cause of acute chest pain in sickle cell patients, and what interventions should be prioritized?
Acute chest syndrome – Oxygen, IV fluids, pain management, and rapid transport
Definition of Lipolysis? When does it occur for pts with diabetes mellitus?
Lipo- (fat), -lysis (breakdwon). Breakdown of fat. Occurs when the body can't utilize glucose for energy.
If this patient is experiencing diabetic ketoacidosis (DKA), how might his respiratory pattern differ from someone experiencing hypoglycemia?
Kussmaul respirations – Deep, rapid breathing to blow off CO2 and reduce metabolic acidosis.
What is the pathophysiologic process responsible for pain and vital sign abnormalities in sickle cell disease?
Vaso-occlusion – Misshapen cells clog capillaries, leading to tissue ischemia, swelling, and pain.
What is the appropriate pediatric dose range of glucagon for a child weighing 18 kg?
0.5mg
Why is a hemophilia patient at a higher risk for intracranial hemorrhage after a head injury?
Hemophilia patients lack clotting factors, which increases their risk for bleeding even without visible trauma.
What is glycogenolysis? What hormone stimulates this response?
Glycogen- (storage form of glucose [not readily available]), -lysis (breakdown). Breakdown of glycogen to form usable glucose.
The hormone glucagon stimulates gylcogenolysis
Give an explanation of the pathophysiology of Hyperosmolar Hyperglycemic State (HHS) in diabetes?
HHS is characterized by extremely high blood glucose levels without significant ketone production. The elevated glucose leads to osmotic diuresis and dehydration, while the presence of some insulin prevents significant ketogenesis.
What is the primary concern for patients taking blood thinners?
High risk of bleeding.
How does glucagon raise blood sugar levels without directly administering glucose?
Glucagon stimulates the liver to convert glycogen into glucose (glycogenolysis), increasing blood sugar levels.
What S/S would cause you to think a patient is in severe DKA? What are interventions will you provide this patient?
S/S: Kussmaul's respirations, a blood glucose reading that is very high (higher than 250mg/dl), and patient has an altered mental status.
Interventions: Airway management, IV/IO access, rehydration with fluid (20 mL/kg bolus) repeat as needed, and rapid transport.
What is the difference between hypoxia and ischemia?
Hypoxia is the lack of oxygen at the tissue level, while ischemia is the lack of blood flow causing oxygen deprivation.
Explain why polyuria occurs in patients with diabetes mellitus.
Due to the high blood glucose levels, the kidneys are forced to excrete some of the excess glucose. Glucose is a polar molecule and will pull excess fluid from the blood when it is getting filtered leaving an excess amount of urine. Because of the excess of urine, there is an increased need to urinate.
How does chronic sickling in sickle cell disease contribute to multi-organ dysfunction?
Chronic sickling leads to infarction, scarring, and dysfunction in the spleen, kidneys, brain, and other organs, increasing the risk of stroke, infections, and renal failure.
What size D10 bolus should be given at one time?
100 mL aliquot.
If a patient’s blood sugar remains critically low after a dextrose administration, what should be the next step?
Administer another dose of dextrose, titrating the dose based on the patient's response rather than giving a full 25g dose again.
Break down the word thrombocytopenia. What does it mean? Why might this condition lead to serious medical emergencies?
Thrombocyt- (thrombocytes aka platelets) -penia (reduced). Reduced platelets.
Individuals with thrombocytopenia can experience severe internal bleeding with little or even no prior trauma.