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Diabetes Emergencies: Recognition, Prevention and Treatment

Pedestrian mishaps, accidents in the home: cuts, burns, etc., regardless of severity are considered emergencies. Some of these may be simply treated with a first-aid kit at home or at work, but some can be life-threatening and need to be attended to in the emergency room by doctors.

Similarly, people with diabetes also suffer from diabetes-related emergencies that may arise due to erratic blood sugar levels, missed meals, accidental overdose of medications, or too much strenuous exercise. These things could affect the sensitive body of a person with g diabetes and could lead to serious incidences of hypoglycemia (low blood sugar) or hyperglycemia (highblood sugar). It is therefore important for those with diabetes to keep their sugar levels normal to prevent complications and to be able to live normal, healthy lives.

DM Emergency Situations According to Dr. Melinda Atienza, president of the Philippine Pediatric Society of Metabolism and Endocrinology (PPSME), children with diabetes usually experience diabetic ketoacidosis (DKA). Dr. Atienza warns that classic symptoms of DKA need to be immediately recognized to prevent further complications and even death. “There are three DKA symptoms: dehydration, hyperglycemia, and metabolic acidosis,” says Dr. Atienza. She adds that if a diabetic child is clinically dehydrated, is breathing fast, and is hyperventilating, their urine produces a fruity odor and their lips are reddish because they are acidotic.

Dr. Atienza says DKA may come about if a child or a teenager misses an injection. She says that teens are the ones who usually miss their insulin shots, either accidentally or intentionally. Physical stress may also lead to DKA.

Dr. Marie Yvette Rosales-Amante, an endocrinologist at the Asian Hospital and Medical Center says that not only does DKA affect children but it also commonly occurs in type 1 diabetes and could also affect patients with type 2 diabetes.
DKA, however, is not the only diabetes-related emergency case that those with the disease should watch out for. Another serious emergency for a diabetes patient is hyperosmolar hyperglycemic nonketotic coma (HHNK), which also occurs when a diabetic patient experiences hyperglycemia.

Treatment and Management
Diabetes emergencies require immediate medical attention to prevent further complications. Both Dr. Atienza and Dr. Amante explain how each emergency situation should be dealt with at the hospital and how to administer first aid, if needed.

Dr. Atienza says that children who are experiencing DKA needs to be hydrated at once through dextrose and given sodium bicarbonate, if needed. “It is also important to lower blood sugar levels by giving insulin,” she explains. In addition, children below five years old must be admitted to the Intensive Care Unit (ICU) to receive utmost attention and care.

First aid may only be administered by adults to children experiencing DKA. They could be asked to drink sugar containing fluids like regular soda or juice. Forcing the child to drink while they are unconscious, however, may lead to choking, and the fluids may go into the lungs which may cause death. In this case, glucagon shots are highly advised.

The same thing can be done to those suffering from hypoglycemia. Dr. Atienza, however, points out that the patient needs to be immediately sent to the emergency room if he or she becomes symptomatic — dizzy, weak, and might lose consciousness — and if the blood sugar level fails to stabilize.

Important Things to Remember
Both Dr. Amante and Dr. Atienza recommend that patients with diabetes should wear their medical IDs at all times or keep their medical information handy, which details their diagnosis, their medications they are taking, or contact information of their doctors, in case these emergencies happen in school, at work, or while they are outside. If they are found unconscious on the street, then these medical IDs could greatly work to their advantage.

Also, it is very important that co-workers or school nurses (for children and teens) know the patient’s condition so that they could help administer first aid and rush the patient to the hospital, if necessary. Dr. Atienza says she gives medical certificates to the school nurse of her pediatric diabetic patients. If something happens to these children, then the nurses would know exactly what to do. By being vigilant, complications in the future, and even death, can certainly be prevented.

Keeping supplies on hand like glucose meters, candies, regular sodas or juices, can also help in preventing hospitalization or any serious circumstances. If blood sugar levels are too low, pure sugar must be given at once, says Dr. Amante, who is also a board director of the American Association of Clinical Endocrinologists (RACE)-Philippine Chapter.

Dr. Amante adds that three to four pieces of candy or half a cup of juice or regular soda should do the trick in normalizing blood sugar levels. Eating chocolates may take some time because of its fat content. If blood sugar is too high, pills are inadvisable as they may also take some time in lowering your blood sugar levels.

According to Dr. Amante, when already in the hospital, the patient is advised to tell the doctor whether he or she has skipped a meal or a medication, exercised too much, recently been sick, and other factors that could cause erratic changes in his or her blood sugar level.

Recognizing an Attack
Dr. Amante says that patients who already know their diabetic pattern can easily recognize symptoms of an emergency situation, either DKA, HHNK or hypoglycemia. She says that she tries to help her patients anticipate an attack by telling them that they must be aware at all times. For instance, if the patient knows that eating little breakfast weakens his body, he must make up for that and take a snack later in the day.

She says, however, that there are times when diabetics fail to recognize a hypoglycemia attack. Dr. Amante shares that there are some whose blood sugar levels are within the 40s range, so their bodies start getting used to it. Unfortunately, when their blood sugar levels drop to 20, without warning, they could just lose consciousness. This is indeed a very risky situation especially if the patient lives alone or if the people he works with do not know that he has diabetes. “Either the person knows the symptoms, then tries to catch up with it, and/or warns people around them or instructs people around him that if this happens to me, try to do this or bring me to the hospital right away,” she explains.

But of course, the best teacher is still experience, says Dr. Amante, especially for those who have had the disease for a long time already. She says, “Once they’ve had diabetes for a long, long time, they know the symptoms, they know howto prevent it, and they know how to treat it. And the important thing is if it happens too often, then you have to go back to your doctor to adjust your medicine.”

Patient Education
Diabetic organizations have been trying to educate more and more Filipinos about diabetes and how to manage the condition by themselves. Whether children, teens, or adults, these patients must have basic knowledge on how to take care of themselves to avoid experiencing emergency situations.

Dr. Atienza further shares that PPSME holds a diabetes camp every summer. In this camp, which is normally held in May, doctors and dieticians teach children to be self-sufficient. “In the camp, they have sessions and lay lectures, and we try to make lectures as simple as possible, to make them understand the importance of nutrition, exercise, insulin shots, why they should not miss it, and the different problems to expect,” says Dr. Atienza.

In addition, the Philippine Society of Endocrinology and Metabolism (PSEM) also has an active advocacy program for patients with diabetes. “Lay fora (most recently in conjunction with PCP annual convention) are being held in the different regions in the Philippines to educate the public about diabetes. The PSEM has a magazine called Hormone Hotspots which also helps in the dissemination of information. PSEM also has partnered with the Liga ng Barangay to teach barangay health workers about diabetes and its complications. These health workers will then echo this knowledge to the patients,” says Dr. Roberto Mirasol, past president of the PSEM and the ASEAN Federation of Endocrine Societies.

There are other diabetes organizations that are greatly involved in diabetes education and the dissemination of information to increase public awareness about diabetes and its prevention such as the Philippine Diabetes Association, the Philippine Center for Diabetes Education Foundation, the Insitutefor the Studies of Diabetes Foundation and more. With the efforts of these groups of medical professionals and others involved in the care and management of diabetes patients, we could only hope that diabetes emergencies can be fully and immediately addressed, if not prevented in the first place.

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