Diabetics

I love diabetics.

That probably sounds awful, but let me explain. Diabetic emergencies are calls that most medics kind of enjoy, at least I do. It's one of the occasions where we carry all the tools and medications in the field with us to make a big difference right away. You get to start I.V.s and administer medications; it's a true ALS call. And we all want to practice the skills we've been trained to perform, right?

We got the call at 0300 last night and dispatch told us we had a 30 year old male unconscious, intoxicated, and diabetic. I thought, well, this one could go either way. Either he's hypoglycemic and I can do something dramatic about it or he's just drunk and I'll poke him with needles and see if he wakes up, hoping he won't puke on me.

We arrived and the patient's girlfriend led us into the bedroom where the patient was unconscious in bed, unresponsive to even painful stimuli (hard sternal rub). If you're wondering what that's like, try having someone take the knuckle of their middle finger and give you a "noogie" right in the middle of your breastbone. Make sure this person knows that you will probably punch them in response.

My patient was extremely diaphoretic, having sweated through the sheets around him. His girlfriend was really scared but, to her credit, held it together and gave us all the information we needed. She told us he was diabetic and had been at a beer festival all day, capping it off with a few shots of Jaeger. She knew what meds he took and told us she checked his sugar earlier and it was at 60 and twenty minutes ago it was at 30. I cannot tell you how important and helpful it is to have a good historian on a medical call. When the family and/or friends can't supply the right kind of information we have to go into what we refer to as "veterinary medicine" mode. That is, you have a patient you know nothing about and can't communicate with.


This patient's girlfriend told me everything I needed to know and I was able to go to work right away fixing this guy's problem.

I checked his sugar with our glucometer and it was low enough to just read "Lo" on the machine, meaning it couldn't even register a number. My firefighter got vitals and oxygen going while my Captain flooded an I.V. line for me. I put the tourniquet on his arm and his veins just started popping up. The needle went right in no problem and the line was flowing great.


A patent I.V. is essential when giving a patient sugar because dextrose is necrotic, meaning if it gets into the tissues and not the vein it will kill the tissues it contacts. While I was starting the line, my firefighter got the D50 (intravenous glucose) ready for me.


I pushed the amp of D50 and waited. After about twenty to thirty seconds I tried the painful stimuli again and my patient started moaning. Within a minute he was talking to us, knew where he was and what was going on. Gotta love that sugar.

Most of the time, once we've performed an ALS intervention (like the I.V.) that means the patient is going to the hospital. With diabetics it all depends. Once you've fixed their sugar problem they are essentially back to normal. Now, the glucose we give is fast acting and doesn't last long, so the patient needs real food and drink to keep his levels balanced. If someone is there to make the patient food and make sure they eat then we can sometimes let them stay home. This patient didn't want to go with the ambulance to the hospital, so his girlfriend got him a burrito, water, and orange juice and we left him in her capable hands. Before we left though, I had to remove the I.V. which is something we almost never do.

So, problem solved we headed back to quarters where I would lie awake in my bunk for the next hour trying to get back to sleep. I'm glad I could help, but the 3 a.m. calls are the worst. If you're lucky, you've been asleep for only about 4 hours and have to get up in three more. That is, if you can get back to sleep right away.