Sons Save Mom Overseas with Webcam says the headline.
OSLO, Norway (AP) — A Web camera in a Norwegian artist’s living room in California allowed her sons in Norway and the Philippines to see that she had collapsed and call for help, one of the sons said Friday.
“My wife is American and she knew exactly whom to call for help,” he said. “It took five or 10 minutes for the ambulance personnel to arrive.”
He said the family was on the verge of tears when they watched on the Web camera as ambulance personnel assisted their diabetic mother, who is recovering in the Desert Valley Hospital in California.
“I thank that camera and my sons for my life,” Karin Jordal told the Norwegian newspaper Bergens Tidende by telephone from her hospital bed. She has lived in the U.S. and Spain on and off for the past 15 years.
Ole Jordal said low blood sugar caused his mother’s collapse, and that she would be allowed to go home after a few days in the hospital. He said the family set up Web cameras in their homes because of the high cost of staying in touch by telephone when they live so far apart.
So what’s up with diabetes? Let’s start with a quick quiz: Add your point scores for each thing that’s true about you.
Score seven or more = talk to your doctor about diabetes.
A while back, a lady came to the walk-in clinic because she had a persistent sore throat. No biggie. Lots of people have those every winter. There I was, happy young EMT, preparing her and getting her history and vitals and charting them so the doctor could get the story and deal with her rapidly and effectively. As is my wont, I finished up (after getting blood pressure, pulse, respirations, a narrative of his chief complaint and so on) with my standard: “Do you have any other health questions or concerns today?”
Turns out she did: She’d read an article in the Reader’s Digest about diabetes, and she had some of the warning signs.
All of them.
Cool. I said to her, “Tell you what. I can do a finger stick on you right now. It just takes a minute, but I gotta warn you, the finger stick hurts a bit. If it doesn’t show anything, I won’t write it down and you won’t be charged. If it does show something interesting, we’ll tell the doctor. Okay?”
Woo whee! Her glucose reading was around 500 mg/dL. That’s like five times normal.
Was she happy? She was not. “I came here with a cold and left with diabetes.”
The word “diabetes” comes from the Greek dia, or “through,” and bainein, “to stand with legs asunder.” The word means “one that straddles; a compass or siphon.” The dia is the same dia as in diabolical and diarrhea. (How to tell you’re going to have a bad day in the ER: When you come in, the person who you’re replacing is finishing up some charts and looks up at you and blearily asks “How many ‘r’s in ‘diarrhea’?”)
One of the main symptoms of diabetes (which is one of the top ten, some say top five, diseases in industrialized countries) is drinking a lot of water, and urinating it away. Diabetes mellitus (mellitus is of or pertaining to honey) is so-called because the urine is sweet — and let’s not mention how medieval physicians diagnosed it.
Here’s why the urine is sweet, and why there’s so much urine involved:
Glucose is the basic carbohydrate that provides energy to the body’s cells. But glucose is a big molecule: Too big to pass through the cell membrane of most cells. To pass through the membrane requires a hormone, insulin, to open a tunnel. If that tunnel doesn’t open, the cell starves for energy, the glucose stays in the bloodstream, and the serum glucose level goes up. Normal is 80-120 mg/dL. In diabetics it’s higher. Lots higher.
When the blood has too much glucose the body tries to flush it out, through the kidneys. That requires a lot of water. So that’s why you’re thirsty all the time — the body needs water to flush out the glucose. And that’s why the urine is sweet. The glucose that should have been feeding the cells is going somewhere, and that somewhere is out.
Meanwhile, you’re hungry all the time, since the cells aren’t getting their energy and are yelling “Hey, boss, we’re starving down here!” The muscles start burning protein — that gives you unexpected weight loss, and it also gives you DKA: Diabetic Ketoacidosis. Ketones in the blood — breakdown products of protein. That turns up as a fruity smell in the breath — ketone-breath — and Kussmaul’s Respirations.
Kussmaul breathing is rapid, deep breathing. Y’see, ketones are acidic. Hemoglobin in the red blood cells carries oxygen, but it only works inside of very narrow pH limits. The blood gets too acidic and the oxygen stops being carried. Things get very bad, very fast, right about then. So the body is trying to raise the pH of the blood by dumping carbon dioxide (also acidic) out through the lungs.
By this time you can be staggering like you’re drunk, slurring your words, and otherwise showing signs and symptoms of altered mental status.
The blood is getting thick, like pancake syrup. That thick blood doesn’t move too well through the capillaries. That leads to bad things — poor circulation (often first in the feet, a long way from the heart, fighting gravity, and kept immobile by shoes) yields sores that don’t heal, then necrosis and gangrene, which is treated by amputation (diabetes is the number one cause of non-traumatic amputation in America). Poor capillary circulation in the retinas leads to death of the rods and cones, and blindness (diabetes is the number one cause of non-traumatic blindness in the non-elderly population in America). All the movement of large molecules through the kidneys, combined with poor capillary circulation, tends to burn out the kidneys. Diabetes is the number one reason for kidney failure requiring dialysis in America.
Did I mention that smoking makes all these things worse?
There are two main reasons why the cell membranes might not be passing glucose: One is that the body isn’t producing insulin. The other is that the body is producing insulin, but the cell membranes aren’t reacting properly to it.
That first kind is Type I diabetes, Insulin-Dependent Diabetes Mellitus (IDDM), also called juvenile-onset diabetes because it’s often first observed when the patient is young. The usual cause is an autoimmune reaction, where the body rejects the Islets of Langerhans in the pancreas, and kills them. No more Islets, no more insulin, no more sugar to the cells. Up until 1922, when injectable insulin became available, that meant a death sentence. The disease is usually rapid onset — weeks or months from clinically normal to a full-blown case. Nowadays, IDDM means that you, your glucose test kit, and a hypodermic are going to be close personal friends for life.
Type II diabetes, adult onset, usually comes on over a period of years. Here, the body is producing insulin but the cells are no longer sensitive to it. Usually, you see this in your older folks, particularly sedentary, overweight people. Oftentimes even a modest weight reduction (5 kilos) will be enough to get the cells to start accepting insulin again and start passing that glucose. Type II diabetes can often be controled by diet, exercise, and, if those don’t work, oral medication, or some combination of the three.
I’m not going to go into gestational diabetes — it’s temporary, treatable, and decent prenatal care is going to find it. (Though 20-50% of the women who develop gestational diabetes will go on to develop Type II diabetes in later life, so you might consider it a red flag.)
I’ve talked about muscle and fat cells and such needing insulin to use glucose. Nerve cells — the brain — don’t need insulin. Glucose passes just fine through those cell membranes. But nerve cells need glucose, and they’re highly sensitive to its lack.
While high glucose levels can lead to unconsciousness and death (diabetic coma), what’ll kill you fast is insulin shock. That’s when a person has taken their normal insulin dose, but for some reason doesn’t have their normal glucose levels in their blood. Forgetting breakfast, unusual exercise, a low-grade fever — lots of things can cause that. The glucose level plummets, the nerves starve, the cells die, and it’s lights out.
Fortunately for us EMS types, this is one treatment that’s fast, easy, and magical. You give the person some sugar, they’re better. You have your oral glucose — 15 grams in a little plastic tube that you can squeeze into the person’s mouth (provided they’re conscious enough to be able to guard their airway). It gets absorbed right through the mucous membranes of the cheek and gums. Those little tubes are expensive, so lots of folks, in their personal kits, carry tubes of squeezable cake decoration frosting. It’s pretty much the same stuff. In some EMS systems, if the patient can’t guard his airway, you’re allowed to give rectal glucose. Pop a hard candy right up there — a mucous membrane is a mucous membrane. (Important safety tip: If you want the person to still be your friend afterward, don’t use a Red Hot Fireball cinnamon candy.)
For higher level EMS providers who can start IVs, you have D50 — a 50% dextrose and water solution. These come in 50 mL prefilled syringes. Start your IV, get your blood samples, and push it on in. The patient wakes right up. (It’s wonderful to watch.)
If you can’t establish an IV, paramedic level providers can give intramuscular (IM) shots of glucagon, a hormone that makes the liver dump all its glucose supplies directly into the bloodstream. (The other emergency medical use for glucagon is to relax the esophagus for people who have a bolus of food stuck in there, to allow it to pass into the stomach.) Glucagon’s tricky because you have to mix it up on scene from a powder dissolved in water.
D50 is part of the old Coma Cocktail, the Party Pack. If you come on an unconscious person and don’t have any idea what’s wrong (no baseball bat mark on the skull), no one saw anything, no medic alert bracelet, you whack him up with three things, all in the Might Help Can’t Hurt range: 50 mL of D50, 100 mg of Thiamine (in case alcohol was the problem) and 0.4 mg of Narcan (blocks opiates in case heroin or summat is what put him out).
Suppose the person had high blood sugar, not low blood sugar, and that’s why he’s unconscious? Well, the D50 won’t hurt, since the patient’s blood is already running so sugary that it won’t make a difference.
Anyway, I can neither diagnose nor prescribe. Nothing here is medical advice for your particular situation. Lots of folks recommend screening everyone for diabetes at age 40, again at age 50, and at random afterward.
Do keep a watch out for diabetes in your life, and in the lives of your nearest and dearest. Around 21 million people in America have it. The CDC calls it an epidemic. Stay safe.
Copyright © 2005 by James D. Macdonald
I am not a physician. I can neither diagnose nor prescribe. This post is presented for entertainment purposes only. Nothing here is meant to be advice for your particular condition or situation.
Sweetness and Light by James D. Macdonald is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 United States License.
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