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Diabetic emergencies

Between 2010 and 2019, the rate of diabetes in South Africa tripled from 4.5% to 12.8%. Even more alarming is that more than half of the 4.5 million people with diabetes aged 20 to 79 don’t even know that they have the condition.

ER24 paramedic Tao Carstens says the most common diabetes-related emergency conditions are hypoglycaemia (extremely low blood sugar level) and hyperglycaemia (extremely high blood sugar level).

Diabetic ketoacidosis (DKA) is a potentially fatal condition that happens after a long period of hyperglycaemia. With DKA, the body breaks down fat for energy so fast that various organic acids as by-product ends up in the bloodstream, making it acidic. Symptoms can include fruit-scented breath, abdominal pain and shortness of breath.

Pre-eclampsia is a blood pressure-related condition some pregnant women experience, which can be aggravated by high blood sugar levels. Look out for nausea and vomiting, headaches, belly pain and blurred vision. This condition is serious and if left unchecked can be life-threatening to mom and baby.

If you suspect someone is experiencing a diabetes-related emergency, call ER24 on 084 124 for real help, real fast. Following this, if the patient is a known diabetic, test their glucose levels to determine whether they’re high or low. Modern glucometers come with an easy-to-use finger-prick device and are simple to operate. If you don’t have a glucometer, Carstens suggests touching the patient’s skin to check if they’re hot and dry, or wet and cold.  Use this simple rhyme to determine the next steps: “Cold and wet, sugar I get; hot and dry, insulin I cry.”

Low vs high blood sugar

If the person is cold and wet, they’re probably experiencing hypoglycaemia (low blood sugar) and it’s important to get their sugar levels up. If the blood glucose reading is extremely low, it can lead to a diabetic coma, in which the patient becomes unresponsive. Carstens says giving the patient something sweet to eat or a sugary drink should help. If the patient is non-responsive, or goes into a diabetic coma, turn them on their side (the recovery position) and put jam, honey or syrup inside their cheeks. “Just don’t put your finger in their mouth,” Carstens adds, “as they may bite when in this disorientated state.”

If the person is hot and dry, it means they have hyperglycaemia (high blood sugar) and need to have their medication administered as soon as possible.

Once ER24 medics arrive, they will test the patient’s blood sugar levels and decide whether the patient needs a drip or just glucose by mouth. “If the patient is unresponsive, we’ll set up a drip and give some dextrose if the glucose is low,” says Carstens. “We also check other vital signs. Dextrose takes about five minutes to work, and after this period we’ll reassess the patient.”

She adds that people in these conditions can become aggressive and stronger than usual, especially if they’re confused, start to panic and adrenalin kicks in. That’s why it’s important to use slow, non-threatening movements to keep them calm, and not to crowd them.