Treating Hypoglycemia with a Spoon, Cake-mate and Gloves
As I have often written, I have the honor to work with an amazingly dedicated Diabetes Team at Children's National Medical Center. I have made many remarks about my diabetes nurse educators, dietician, social worker, and psychology team, but I never talked about the infrastructure that enables our team to function on a day-to-day basis. We have three administrative assistants who "direct traffic." They triage emergency phone calls to the appropriate diabetes team member, answer routine phone calls for appointments, and direct blood sugar logs, prescriptions, questions to the staff. Sometimes, they even give directions to Children's National as families travel to appointments. Many people do not realize that as a result of "living" with the Diabetes Team members, the administrative assistants have become extremely well-educated about Diabetes management and especially what truly consists of an "emergency situation."
Yesterday, one of my administrative assistants who often handles diabetes-related issues told me an amazing story. She was driving home in the District of Columbia and parked her van directly in front of her home. Several minutes later, she heard a crash and ran outside to see what occurred. She found that a pick-up truck had crashed into her van and that the driver, a man in his 50s or 60s, was unconscious. My sharp co-worker noticed a blood glucose machine sitting on the front seat. She immediately called for her son to get a spoon, cake-mate, and gloves and bring them to the crash site. She applied the cake-mate to the man's gums and he began to gain consciousness, although he remained confused and did not regain his faculties. The paramedics arrived and administered dextrose. He was brought to a hospital for further management and ended up being admitted to the intensive Care unit. Apparently, the gentleman had other underlying serious medical problems that needed prompt attention.
The paramedics immediately told my co-worker that had it not been for her prompt attention to this situation, and noticing the blood glucose meter, he would not have survived!
What is the underlying message in this story?
Although she is not a physician or nurse, she is a bright medical assistant and member of our Diabetes Team who is well-versed in the treatment of hypoglycemia. Last week, we addressed "what are ketones" and how to treat them; today we are addressing the serious emergency that may occur with hypoglycemia. I have congratulated my team member on her prompt response. The key, however, is how to avoid hypoglycemia in the first place (and then knowing how to correct the situation immediately if it occurs). This brings up one of my biggest concerns: Driving and Diabetes.
I am always asked to sign learner's permits and driver's license forms. The state of Maryland requires signatures of the physician stating that the adolescent appropriately manages his diabetes. Prior to signing any forms, I require that my emerging drivers check blood sugars at least four times/day for at least 3 months to make certain that they have become used to the need for checking and the habit has become routine. They also are required to check blood sugars before driving to ensure that they will decrease the risk for hypoglycemia. We ask that the driver carry rapid acting carbohydrate on their person at all times as well as having a cache of carbohydrates in the vehicle. I am rather strict about this, and my young patients often bristle when I enforce this requirement. But, I have never felt any remorse for this edict.
I am proud to be associated with my Diabetes Team members that work behind the scenes and understand what consists of true diabetes-related emergencies. Keep in mind, that indirectly, all family members who care for people with diabetes are part of the global "diabetes team" and that at some point you may be called to act in a true emergency to help someone with hypoglycemia. It is important to know what to do in the immediate situation and how to help decrease or prevent future hypoglycemic emergencies.