Diabetes

Diabetes mellitus is a medical condition where the body is unable to effectively regulate the amount of sugar in the blood. The pancreas (an organ in the body) normally produces a hormone called insulin that regulates blood sugar level. In a person suffering from diabetes this does not happen effectively and as a result blood sugar levels become too high (this is known as hyperglycaemia). Most diabetics control the condition through a combination of diet and injection of insulin. Too much insulin can lead to a condition known as hypoglycaemia (low blood sugar).

Hyperglycaemia

Hyperglycaemia is most likely to occur in an undiagnosed diabetic. Diabetes is generally first noticed in early adolescence or in middle age. If left untreated, a high blood sugar level will lead to unconsciousness and death. Onset may be gradual with deterioration often happening over a number of days.

Signs and symptoms

Early signs:

• Wanting to drink a lot (the body is trying to flush sugar from the system)
• Passing water regularly (urine may smell sweet)
• Lethargy

As the condition deteriorates:

• Dry skin and rapid pulse
• Deep, laboured breathing
• Increasing drowsiness
• Breath or skin smells strongly of acetone (like nail-polish remover) as the body tries to get rid of sugar

Treatment

During the early stages, encourage immediate contact with the local doctor. If this is difficult, or the condition deteriorates, take or send the person to hospital. Monitor airway and breathing and be prepared to resuscitate if necessary.

Hypoglycaemia

Low blood sugar level has a quick and serious effect on the brain. Most commonly it is caused by somebody with diabetes either taking too much insulin, or taking the right amount of insulin and then either not eating enough or burning off sugar through vigorous exercise. Less commonly, it can accompany heat exhaustian, alcohol abuse or epileptic fits.

Signs and symptoms

• History of diabetes (however, a diabetic suffering a hypoglycaemia attack is often confused or aggressive and may not admit to having diabetes)
• Hunger
• Feeling faint or dizzy
• Strange behaviour: confusion, aggression or even violence
• Pale, cold, sweaty skin
• Rapid loss of consciousness
• Shallow breathing
• Evidence of diabetes, e.g. medic alert, sugar solution or syringe in pocket
• Evidence of recent heavy exercise or drinking

Treatment

If the person is unconscious, monitor the airway and breathing and be prepared to resuscitate as necessary.

If the person is fully conscious, help him to sit down or to lie down with the shoulders raised. Give something high in sugar and easy to consume, such as chocolate or a sugary drink, to try to restore the body's chemical balance. If this marks an improvement, give more. If the conditian does not improve, seek medical advice. Stay with the person until he recovers. Ask his guidance on what he wants to do next. Arrange for some help to take him home or to the doctor. If the condition continues to deteriorate, call an ambulance.

Confusion with other conditions

It is not unusual for diabetes to be mistaken for other common situations such as drunkenness, substance abuse, compression or a stroke. The treatment in all these situations is to monitor and maintain the airway, be prepared to resuscitate if necessary, use the recovery position if the person becomes unconscious and seek medical advice or call emergency help.

Do not make assumptions as to the cause of the problem. Instead, look for clues to diagnosis for the medical staff. Somebody who is drunk may also be suffering from head injury; the syringe in a person's coat may be for diabetic medication or for drug abuse. While you do not need to know the cause the medical staff do and any clues that you can hand over could be potentially life-saving.