Worst Case Scenario: Diabetic Coma

Diabetic coma is an emergency. You cannot be prepared in advance. If you have the feeling of an extreme high or low blood sugar you should call your local emergency number. You need to ensure help before you pass out.

If there is a person with you instruct him/her about it. If this person is familiar with diabetes care he/she should:

Test your blood sugar.
If the blood sugar level is lower than 70 mg/dL (3.9 mmol/L), administer an injection of glucagon. If glucagon isn’t available, rub glucose gel, honey or non-sugar-free syrup on the inside of the unconscious person’s cheek. No insulin should be given!
If the blood sugar level is above 70 mg/dL, wait for medical help to arrive. Don’t give sugar to someone whose blood sugar isn’t low.

Let the emergency care team know about the diabetes and what steps have been taken, if any.

I found a blister on my foot, what should I do?

Diabetes complications include nerve damage and poor blood circulation. These problems make the feet vulnerable to skin sores (ulcers) that can worsen quickly and are difficult to treat. Proper diabetes management and careful foot care can help prevent foot ulcers.

When foot ulcers do develop, it’s important to get prompt care. An ulcer that won’t heal causes severe damage to tissues and bone and may require surgical removal (amputation) of a toe, foot or part of a leg.

Here’s what you need to know to keep your feet healthy, and what happens if amputation is necessary. (Hyperlink)

Vaccinations

Keep your vaccines up to date.

High blood sugar can weaken your immune system, which makes routine vaccines more important than ever. Ask your doctor about:

Flu vaccine. An annual flu vaccine can help you stay healthy during flu season as well as prevent serious complications from the flu.
Pneumonia vaccine. Sometimes the pneumonia vaccine requires only one shot. If you have diabetes complications or you’re age 65 or older, you may need a five-year booster shot.
Hepatitis B vaccine. The Centers for Disease Control and Prevention (CDC) currently recommends hepatitis B vaccination if you haven’t previously been vaccinated against hepatitis B and you’re an adult aged 19 to 59 with type 1 or type 2 diabetes. The most recent CDC guidelines advise vaccination as soon as possible after diagnosis with type 1 or type 2 diabetes. If you’re age 60 or older and have diabetes and haven’t previously received the vaccine, talk to your doctor about the whether it’s right for you.
Other vaccines. Stay up to date with your tetanus shot and its 10-year boosters. Depending on the circumstances, your doctor may recommend other vaccines as well.

Foot Treatment

Begin taking good care of your feet today. Set a time every day to check your feet.

Check your feet on a daily basis. Look at your bare feet for red spots, cuts, swelling, and blisters. If you can’t see the bottoms of your feet, use a mirror or ask someone to help.

Wash your feet daily. Wash your feet in lukewarm water once a day. Dry them gently, especially between the toes. Use a pumice stone to gently rub the skin where calluses easily form. Sprinkle talcum powder or cornstarch between your toes to keep the skin dry. Use a moisturizing cream or lotion on the tops and bottoms of your feet to keep the skin soft.

Don’t remove calluses or other foot lesions yourself. To avoid injury to your skin, don’t use a nail file, nail clipper or scissors on calluses, corns, bunions or warts. Don’t use chemical wart removers. See your doctor or foot specialist (podiatrist) for removal of any of these lesions.

Keep your skin soft and smooth. Rub a thin coat of skin lotion over the tops and bottoms of your feet, but not between your toes.

If you can see and reach your toenails, trim them when needed. Trim your toenails straight across and file the edges with an emery board or nail file.

Wear shoes and socks at all times. Never walk barefoot.

Wear clean, dry socks. Wear socks made of fibers that pull (wick) sweat away from your skin, such as cotton and special acrylic fibers — not nylon. Avoid socks with tight elastic bands that reduce circulation, as well as thick bulky socks that often fit poorly and irritate your skin.

Buy shoes that fit properly. Buy comfortable shoes that do not fit tightly and that provide support and cushioning for the heel, arch and ball of the foot. Avoid high heels or narrow shoes that crowd your toes. If one foot is bigger than the other, buy shoes in the larger size. Your doctor may recommend specially designed shoes (orthopedic shoes) that fit the exact shape of your feet, provide cushioning and evenly distribute weight on your feet.

Protect your feet from hot and cold. Wear shoes at the beach or on hot pavement. Don’t put your feet into hot water. Test water before putting your feet in it just as you would before bathing a baby. Never use hot water bottles, heating pads, or electric blankets. You can burn your feet without realizing it.

Keep the blood flowing to your feet. Put your feet up when sitting. Wiggle your toes and move your ankles up and down for five minutes, two or three times a day. Don’t cross your legs for long periods of time.

Don’t smoke. Smoking impairs circulation and reduces the amount of oxygen in the blood. These circulatory problems can result in more severe wounds and poor healing. Talk to your doctor if you need help to quit smoking.

Schedule regular foot checkups. Your doctor or podiatrist can inspect your feet for early signs of nerve damage, poor circulation or other foot problems. Schedule foot exams at least once a year or more often if recommended by your doctor.

Take foot injuries seriously. Contact your doctor if you have a foot sore that doesn’t begin to heal within a few days or other persistent problems with your feet. Your doctor will inspect your feet to make a diagnosis and prescribe the appropriate course of treatment

During a hypoglycemic event

Treatment

Consume 15-20 grams of glucose or simple carbohydrates
Recheck your blood glucose after 15 minutes
If hypoglycemia continues, repeat.
Once blood glucose returns to normal, eat a small snack if your next planned meal or snack is more than an hour or two away.

15 grams of simple carbohydrates commonly used:

glucose tablets (follow package instructions)
gel tube (follow package instructions)
2 tablespoons of raisins
4 ounces (1/2 cup) of juice or regular soft drink (not diet)
1 tablespoon sugar or honey
8 ounces of nonfat or 1% milk
hard candies, jellybeans, or gumdrops (see package to determine how many to consume)

Glucagon

If untreated, hypoglycemia may lead to severe consequences, such as unconsciousness or even coma. In case of unconsciousness someone else should be ready to take over.

There is a hormone, glucagon, able to stimulate your liver to release stored glucose into the blood. In case your blood sugar level is too low, you may need injectable glucagon kits. These kits are used as a medication to treat somebody who has become unconscious. Your doctor is the one that can prescribe glucagon kits. You may ask him/her whether it would be useful for you to have one home, and if need be, how to use it properly.

If you possess a glucagon kit then you should instruct people with whom you are in frequent contact on how to use it in case it is ever needed.

If glucagon is needed:

Inject glucagon into the individual’s buttock, arm, or thigh, following the manufacturer’s instructions.
When the individual regains consciousness (usually in 5-15 minutes), they may experience nausea and vomiting.
If you have needed glucagon, let your health care provider know, so they can discuss ways to prevent severe hypoglycemia in the future.

Do not:

Inject insulin (it will lower blood glucose even more)
Provide food or fluids (individual can choke)
Put hands in mouth (individual can choke)

During a hyperglycemic event

Treating Hyperglycemia

Your blood sugar level can be lowered by exercising. However there is a counter indication to that. In case your blood sugar level is above 240 mg/dl, you may check your urine for ketones. If you have ketones, you should not exercise. Exercising with ketones is counterproductive, and may make your blood sugar level even higher.

Making changes in your food intake can help as well. Your dietitian can help cutting the amount of food you eat. If exercising and dieting are not enough then your doctor may change your medication or insulin, or even the timing of that.

Work with your doctor to find the safest way for you to lower your blood glucose level.

Hyperglycemia can be prevented with good diabetes management. Another important practice is to learn to detect hyperglycemia early so that you can treat it before it worsen.

Who is likely to suffer from Diabetes?

If you are reading this website you have probably already been diagnosed with diabetes. However if you have any doubt that somebody next to you may suffer from it here you find some practical information.

An easy way to understand if somebody is at risk of type 2 diabetes is to respond to a standard questionnaire. They are available online and in many languages (i.e. The Finnish Type 2 Diabetes Risk Assessment Form). This kind of questionnaire aims at providing a result on the probability of developing type 2 diabetes in the next ten years. Some of them also give information on how to reduce this risk. In case of an high level of risk however it is important to have the opinion of an expert.

Beyond taking the various tests you should be aware of the symptoms. If you suspect diabetes you should contact a doctor. It is possible to live with diabetes and to conduct a normal life. However the sooner one get the diagnosis the better the treatments work.