Thursday, March 28, 2024

EMS Endocrinological Emergencies - Diabetes Mellitus

EMS providers should have a comprehensive understanding of diabetes mellitus and its various manifestations, including prediabetes, type 1 diabetes, and type 2 diabetes, as well as potential endocrine emergencies associated with these conditions. 

Here is an overview of each, along with potential issues as they relate to prehospital care:

Diabetes Mellitus (DM): Diabetes mellitus is a chronic medical condition characterized by dysregulation of blood glucose levels. This occurs when the body either does not produce enough insulin (type 1 diabetes) or cannot effectively use the insulin it produces (type 2 diabetes). 

Prediabetes is a precursor to type 2 diabetes, where blood sugar levels are higher than normal but not yet high enough to be classified as diabetes. EMS providers should be familiar with the signs and symptoms of diabetes, which may include frequent urination, excessive thirst, unexplained weight loss, fatigue, and blurred vision.

Hypoglycemia: Hypoglycemia occurs when blood glucose levels drop below normal levels, typically defined as less than 70 mg/dL. This can happen in individuals with diabetes who take insulin or certain oral medications, especially if they miss meals, exercise excessively, or have an imbalance between insulin and carbohydrate intake. 

Symptoms of hypoglycemia can range from mild (sweating, trembling, hunger) to severe (confusion, seizures, loss of consciousness). EMS providers should be prepared to recognize and treat hypoglycemia promptly with oral glucose or intravenous dextrose, depending on the severity of the episode.

Diabetic Ketoacidosis (DKA): Diabetic Ketoacidosis is a life-threatening complication of diabetes, most commonly seen in individuals with type 1 diabetes but can also occur in type 2 diabetes under certain circumstances. DKA develops when there is a severe shortage of insulin, leading to the accumulation of ketones (acidic byproducts) in the blood. 

Symptoms of DKA may include excessive thirst, frequent urination, abdominal pain, nausea, vomiting, fruity breath odor, rapid breathing, and confusion. EMS providers should recognize the signs of DKA and initiate appropriate treatment, which typically involves intravenous fluids, insulin therapy, and correction of electrolyte imbalances.

Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNS): Hyperglycemic hyperosmolar non-ketotic syndrome is another severe complication of diabetes, primarily seen in individuals with type 2 diabetes. HHNS develops when blood glucose levels rise to extremely high levels, leading to dehydration and hyperosmolarity (increased concentration of solutes in the blood) without significant ketone production. 

Symptoms of HHNS may include extreme thirst, dry mouth, confusion, weakness, and coma. EMS providers should be vigilant for signs of HHNS in patients with diabetes, particularly older adults or those with other comorbidities, and initiate prompt treatment with intravenous fluids and insulin therapy.

In summary, EMS providers should be well-versed in the management of common endocrine emergencies associated with diabetes mellitus, including hypoglycemia, diabetic ketoacidosis (DKA), and hyperglycemic hyperosmolar non-ketotic syndrome (HHNS). Prompt recognition and appropriate intervention are essential for optimizing patient outcomes and preventing further complications in these potentially life-threatening situations.


The term "diabetes mellitus" has its roots in ancient Greek and Latin:

Diabetes: The word "diabetes" originates from the ancient Greek word "diabētēs," which means "siphon" or "to pass through." The ancient Greek physician Aretaeus of Cappadocia, who lived in the 1st century CE, used this term to describe a condition characterized by excessive urination, likening it to water passing through a siphon.

Mellitus: The word "mellitus" is derived from the Latin word "mel," meaning "honey" or "sweet." This term was added to distinguish diabetes mellitus from another condition known as diabetes insipidus, which is characterized by excessive urination but does not involve high levels of sugar in the urine. The addition of "mellitus" reflects the presence of sweet-tasting urine in individuals with diabetes mellitus due to the excretion of glucose in the urine.

Therefore, the term "diabetes mellitus" refers to a condition characterized by excessive urination with sweet-tasting urine, reflecting the classical symptoms observed by ancient physicians such as Aretaeus of Cappadocia.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice Volume 2 (6th Ed) Pearson.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

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