Paramedicine is designed to address numerous medical emergencies; with the longest treatment we provide being the time it takes to get to the emergency department. Therefore, our interactions with chronic conditions include short term, life saving interventions that don’t address the chronic aspect of chronic diseases. Though we need a broad background on what many of these conditions are, and how their comorbidities may affect the symptoms we are seeing, we have no one conditions that is most prevalent. With that being said, I will highlight a chronic disease that has been increasingly prevalent as the world faces an obesity epidemic.
Type 2 diabetes (T2DM), formerly non-insulin dependent diabetes mellitus, is a largely preventable illness that has widespread effects on the body. Though there are genetic components, T2DM is largely considered a lifestyle illness, and a change in lifestyle can decrease or removed the need for medication and treatment. Contributing factors include being overweight, poor diet, or lack of exercise. In paramedicine, diabetic emergencies are ever-present among the patient population, as an individual may have issues managing their blood sugar levels resulting in altered levels of consciousness, have extremity issues like neuropathy and paresesthia, or are unable to keep wounds clean resulting in sepsis. All of which can cause secondary issues like falls, leading to trauma or head injuries. As first point of contact during an incident, it is important that we not only treat the issues that inspired the call for 911, but also the underlying issue. If a person is suffering chronic falls, and has difficulty managing their diabetes, the falls may be a result of hypoglycemia. Making these connections and relaying them to the appropriate healthcare team during transfer of care ensures that the patient gets treated for their hypoglycemia, and not just the injured ankle. But the goal is to treat preventatively, not reactively. Continued education and support from relevant resources remind us to make the time for our health, and provide opportunities to access services we didn’t know were available.
A journal article by Punthakee et al. found on the Canadian Journal of Diabetes website provides metabolic values, definitions, and pathophysiology underlying both types of diabetes mellitus (2018).
One resource for insulin or non-insulin dependent diabetes is Diabetes Canada, which provides articles, tools, links, and resources on diabetes, allowing you to make a more informed decision. From planning meals to explaining the impact of physical activity on diabetes, the website offers an easy to use and nationally recognized resource to keep you informed on the latest information regarding diabetes and diabetes research. Additionally, they provide access to support programs where you can attend meetings and online classes to help discuss and address the difficult aspects of living with diabetes. As we know from ecological models, the social environment surrounding an individual can influence them greatly, so a support group may provide renewed vigor to manage diabetes.
For those in Ontario, there are also financial support initiatives to help Ontarians manage their diabetes, or receive financial assistance if their diabetes renders them unable to work. The Ontario website provides links to further resources, outline assistance programs, like their Assistive Device Program, which helps provide medical equipment for those requiring insulin as part of their treatment and management.
From a paramedic perspective, our guidelines, which can be found on my Paramedicine page, require we assess a patient’s blood sugar levels anytime there is a loss of consciousness, the patient is displaying altered behaviour, or experiencing stroke-like symptoms. In Ontario, if the patient’s blood glucose is below 4.0mm/L, we treat with; oral glucose (if the patient is alert and can maintain their airway), a glucagon injection, or dextrose through an IV. According to the companion document that accompanies the ALS PCS, the best way to increase a patient’s blood sugar is with oral glucose, as it forces the body to digest the sugars we provide them in a natural way, without affecting the glycogen stores in the muscles. Dextrose would be the next best approach as it places the sugar directly into the circulatory system, allowing the brain to immediately benefit from the dextrose, without disturbing the glycogen stores in the skeletal muscle. The least preferred method is with glucagon, because it encourages the glycogen stores in your muscle to empty, meaning an immediate raise in blood sugar to feed the brain, but then the body is running on reserved power, and a subsequent drop in blood sugar is imminent. Theses guidelines reflect current best practice, and are reevaluated every year based on new, peer reviewed evidence.
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