Just gave hypo emergency info over phone!

[viranth]

A work colleague just called me, he was at a scene of an accident (crashed car). A person was shaking and eyes wide open, he had diabetes and my colleague asked me what to do.

I had to really think fast here, I asked if he had any blood glucose monitoring system on him, the answer was no. Then I figured that he should get sugar fast, but they said he didn't want any. Then I said give it to him anyway!

It's hard to know what to do over the phone, since I could see what a hypo person looks like, but it's sort of hard when someone who has no idea and multiple persons talking on the phone tries to get info.

The call took about 2 minutes and I made sure he got something to drink (coke is what they had) and some bread (so the BG won't drop right after the coke is gone, if he's been a bit heavy on the insulin today).

I'll get more information about this tomorrow, when work starts again after the holidays.

Hope the guy is allright, this story will definately be in the newspaper tomorrow.

[shiftzor]

That’s a hard call to make; he could have been too high. Chances are you where right he was too low. My advice for what it’s worth :D would always be to call for the ambulance first, then test the bg and follow up with a correction of either insulin or sugar. Not too far from what you did. It’s very careless of a diabetic not be carrying their bg meter with them never mind get themselves into a mess like that. I know that I don't know the full story, hope he’s oki.

[viranth]

Oh, I also asked if he smelled "weird" as in acetone, and they said yes.

So I'm pretty sure I was right by telling them to give him food, no matter what.

[Real4]

Oh, I also asked if he smelled "weird" as in acetone, and they said yes.

So I'm pretty sure I was right by telling them to give him food, no matter what.

Actually, "'weird' as in acetone" would be a sign of ketones, which would mean very high blood glucose levels. But a little more, glucose to someone in Acid Ketosis won't matter very much, but could kept someone with a low from going into a coma.

[xMenace]

I think you did great!

He may have been in shock too.

[Lizzie G]

Actually, "'weird' as in acetone" would be a sign of ketones, which would mean very high blood glucose levels. But a little more, glucose to someone in Acid Ketosis won't matter very much, but could kept someone with a low from going into a coma.

yes thats what i was thinking when i read the post. and same thing re adding an extra 15g of sugar - getting to ketoacidosis takes prolonged periods of carbohydrate intake far exceeding availability of insulin, IMO hypo treatment would make little difference (raising BG by 2 or 3 mmol/l when the damage is already done....) and the advice would always be treat it as if a hypo til the medics arrive (99% it will be....i mean, if you are a diagnosed diabetic DKA doesnt just appear suddenly when you are driving your car does it?!!!)

[shiftzor]

Excuse my ignorance but couldn't that indicate that the patient was high or low. Definitely not oki. Ketosis for a low bg would be possible assuming that the body released all its glycogen reserves and started breaking down other sources of energy. Drop rate would be variable depending how much basal and bolus was floating about, resulting in a prolonged low. At least that’s my understanding, happy for someone to correct me.

[viranth]

I'm really not sure if acetone smell is a low or high sign, cause that just popped into my head when I was talking on the phone, and I had read on a site that it was a sign for low.

For example this one: Press Release - Las Vegas DUI Lawyer Reports Diabetics Can Be Falsely Accused of DUI (http://www.24-7pressrelease.com/view_press_release.php?rssID=12508)

I thought ketoacedosis would make you drowsy-ish, vomit and stuff like that, but not shake uncontrollably and stuff like that.

[lilituc]

Some people smell that way after an extended low, too, so it's hard to say.

[Eddy]

Good call. Like Real4 said, the risk of adding a bit of glucose is small; the upside is well worth it.

Boo on the driver for not carrying glucometer and supplies. I think that's just as negligent as intoxicated driving.

[Eddy]

if you are a diagnosed diabetic DKA doesnt just appear suddenly when you are driving your car does it?!!!


DKA... yuck! I only have one data point (which is more than enough for my tastes), but I was still conscious and coherent after about 20 hours of vomiting and excruciating GI h***. Moreover, that was immediately prior to DX, when I was taking no insulin whatsoever. Of course, my data point could be an outlier; however, others' commentary in other threads leads me to believe that it is not.

[lilituc]

DKA... yuck! I only have one data point (which is more than enough for my tastes), but I was still conscious and coherent after about 20 hours of vomiting and excruciating GI h***. Moreover, that was immediately prior to DX, when I was taking no insulin whatsoever. Of course, my data point could be an outlier; however, others' commentary in other threads leads me to believe that it is not.

I was just thinking, it certainly could happen if someone was misdiagnosed as Type 2.

[Lizzie G]

I was just thinking, it certainly could happen if someone was misdiagnosed as Type 2.

true enough, but surely they would know something was up when their meds/diet control still resulted in massive highs?

[shiftzor]

Maybe but if they didn't know what the signs meant or didn't act on them then it could have fatal consequences. Why does adding sugar to a high person have less impact than adding insulin to a low person, surely both would result in death? I have instructed people to phone an ambulance first and not to feed me anything unless they can test my bg. Maybe this thread should become a sticky or a similar thread made with the correct diagnosis as it could save someones life one day.

[Eddy]

true enough, but surely they would know something was up when their meds/diet control still resulted in massive highs?


Unless, of course, their doctor blindly asserted that the patient was doing things incorrectly.


Why does adding sugar to a high person have less impact than adding insulin to a low person, surely both would result in death?


Maybe my thinking is wrong, but what's an additional 100 mg/dL when one is already, e.g., over 500? Conversely, 100 mg/dL can go a decent ways toward stopping all but the nastiest of hypos.

And if one has such a nasty hypo that 100 mg/dL is insufficient, yet had no testing/correcting supplies along... then I'm inclined to believe that one was horribly reckless.

*shrug*

I tell people never to administer insulin if I were "out of it", but that's my one big "don't". Test first; if that's not possible, just give me sugar and/or glucagon.

In any case, call EMS.

P.S.: Excepting one uebernewbie panic binge (back when I thought mid-50s was scary!), I've not been over 270 since DX. I have, however, had plenty of hypos. If I'm goofy-headed, the smart money bets on a hypo. Nota bene: Thankfully, I'm yet to fall ill, so I may have skewed sampling and an incorrect philosophy. However, all in all, the past 15 months indicate that I'm at far greater danger of hypos.

[UpNorth]

Well done Viranth!
It's always better to assume it's a low unless a high can be proven. But seriously, i can't believe people don't have their monitor and supplies with them in the car:mad: I don't even go to the supermarket by walking or bike, and it's 5 minutes away, without carrying at least my monitor and hypo fix...

[IrishJoe]

sugar would be my reply. if theyare DKA then more sugar isn't going to effect them in the grand scheme of things.

Although if someone was on the *ground* or 'spasticating' as i describe it to my younger brother then its orange syringe (ie glugagon) time!