Diabetes
Emergency Treatment | Implications for Sailing
Diabetes is a disorder of the system which regulates the amount of sugar in the blood. Diabetics risk long term complications due to high blood glucose. These complications may affect eyes, kidneys, and nerves. Arteries, especially those supplying the heart, brain and legs may also be affected. Often blindness and amputations are due to diabetes. Diabetes is an inherited disease. A person who has a family history of the disorder has the tendency to develop it carry it on to their off spring. There are two types of diabetes.
- Insulin Dependent Diabetes. This type is most common in children or young adults. These people produce little or no insulin. The treatment is daily insulin injections, diet and exercise.
- Non Insulin Dependent Diabetes. This generally affects middle aged or elderly people. These diabetics are able to produce some insulin, they don't need insulin injections. Diet alone or diet and tablets may be the treatment used.
Causes
It is caused by a failure of the pancreas to produce a sufficient supply of the hormone Insulin. Insulin allows the sugar to leave the blood and enter the body cells to fuel them. Without insulin the sugar in the blood rises far beyond normal.
DIABETIC REACTIONS
There are two possible reactions from which diabetics may suffer Insulin Reaction and Diabetic Coma.
1. INSULIN REACTION
This is the most common complication of diabetes and is due to a drop in the blood sugar level.
Cause of Insulin Reaction:
Delaying/missing meals; Delaying/missing afternoon or morning tea; Insulin injected was more than needed dose; Unusual strenuous exercise; Emotional shock; Alcohol; Choice of injection site eg. changing from abdomen to leg; Injecting insulin into a muscle or blood vessel, this can increase the blood insulin level rapidly.
Symptoms
Can include: - sweaty (cold & clammy), pale, trembling, headache, dizziness, dilated (widened) pupils, blurred vision intense hunger, unusual behaviour eg. bad temper, poor co-ordination, staggering walk, convulsion, coma
Symptoms depend on the severity of the reaction. The signs vary between people. A diabetic should know his warning symptoms.
2. DIABETIC COMA - KETOSIS
Ketosis is a serious complication due to insufficient insulin
Causes of Ketosis
Omission of a dose of insulin, Insufficient insulin in dose, Infections eg. Flu, Gastric upset, Neglect of diet, Injury, Severe injury, Excessive alcohol consumption
Symptoms
Include: - heavy urine glucose, ketones in the urine, thirst, frequent urination, hunger, fatigue, blurred vision, deep rapid breathing, vomiting, coma - if untreated death
- Give drinks sweetened with 2 full tablespoons of sugar or glucose.
- If dramatic recovery occurs it is an "Insulin Reaction" - give more sugar every 15 minutes for an hour.
- If it is "Ketosis" giving sugar will not harm them but you must SEEK URGENT MEDICAL ATTENTION if recovery isn't obvious.
- If unconscious put the person in the coma position and SEEK MEDICATION ATTENTION IMMEDIATELY.
DIET
It is important that diabetics are very conscious of their diet for a number of reasons. Diet can help to control the blood glucose level and diabetics need to maintain a desirable body weight.
Important points about diet:
- Meals and snacks should be eaten at approximately the same time every day.
- Meals must not be missed.
- Meals should be planned to provide an even food intake.
- Added sugars should be limited, alternative sugars are advised.
- Foods which contain a high amount of sugar should be avoided.
- Alcohol should be had in moderation. Alcohol is high in kilojoules and it may react adversely with some medications
- Unusual amounts of exercise or excitement may require the adjustment of treatment or an insulin reaction may occur.
- Sensory impairment reduces the diabetics perception of pain, injuries may go unnoticed or be perceived as minor.
- Sailors with diabetes are very susceptible to infections and they tend to have poor healing capacities. Infections through cuts, blisters etc. should be avoided. As their skin is so sensitive it may be advisable to wear foot covering. Circulatory restrictions should also be avoided. Tight wet suits may not be suitable.
- Sunburn can cause infections, it also affects blood sugar levels.
- Sailors may desire privacy when testing their sugar level or when administering injections.
- Organisers should be aware that diabetics cannot miss or delay meals. Insulin needs to be kept in a cool place, preferably a refrigerator. Fast acting sugars eg. lollies and orange juice should be readily available in case of an insulin reaction.
