Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

Chapter 10: Problems with Sugar

Diabetes has become a common chronic medi- cal problem so practitioners in any environment are likely to see a diabetic patient at some point. Fortunately, most diabetics are well-informed and do a good job of managing their disease. It is very likely that your diabetic client or traveling partner will know much more about it than you do. It is worth having a pre-trip discussion with the patient about anticipated problems and the appropriate treatment. It is also worth reviewing the patient’s experience with managing his or her disease in similar situations.

Diabetic Emergencies Diabetes is, in basic terms, the inability to produce the appropriate amount of insulin in response to rising blood glucose levels. Insulin is a hormone produced in the pancreas. One of its primary jobs is to help facilitate glucose uptake into body cells where it is processed and stored for use as fuel. When the diabetic patient eats, blood glucose lev- els rise as they do in everyone, but insulin levels do not rise enough to meet the need. Supplemental insulin is usually injected or inhaled in a pre- scribed amount to match the glucose content of the meal. Patients often adjust the amount of insulin and sugar intake in response to changing environ- mental conditions and activity. Most can monitor blood glucose at any time with a portable glu- cometer. It is rare for a conscientious patient to have a diabetic emergency while living within a well-established routine. Hypoglycemia Unfortunately, many backcountry and marine situations are far from well-established routine. Even a well-controlled diabetic can have trouble adjusting to a new environment. The problem is

General Principles

Monitoring Blood Sugar

“Many diabetic patients can monitor blood sugar regularly, and adjust diet and insulin dosage accordingly.”

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Some diabetics manage their disease with oral medication in the form of pills. More significant cases use insulin by injection, infusion pump, or oral spray. The latter group is more likely to have problems in a new environment.