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Learn to spot a diabetic emergency to minimize danger, help guest recover

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One of your passengers is not feeling well so you call your medical service and they instruct you to check the patient’s blood glucose level.



You may wonder why they would ask you to do that. It’s because more than 25 million people in the United States alone (220 million worldwide) have diabetes, a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar.



Hyperglycemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels.

Almost half of diabetes deaths occur in people under the age of 70, and more than half of diabetes deaths are women.



Yacht crew should be able to recognize diabetic emergencies. If one of your guests has diabetes and knows it, they may be able to tell you what is wrong and how you can assist them. However, your guest may be unaware they have diabetes or their symptoms may have progressed to the point of confusion.

Some signs and symptoms include dizziness, drowsiness, rapid breathing, lack of coordination, rapid pulse, sweating but the skin is cold to the touch, weakness, shaking, headache, irritability, bizarre or combative behavior or nervousness. Often, a diabetic in need of their medicine may have a fruity odor to their breath.



If you know a person is diabetic and he or she is experiencing symptoms and they are conscious, give them something to eat or drink that contains plenty of simple sugar, such as candy, fruit juice, honey or non diet soda. If the person is suffering from low blood sugar, or hypoglycemia, the sugar will help within minutes.



If the person is feeling ill because of high blood sugar, or hyperglycemia, he or she will not be harmed by the extra sugar but you must make arrangements to get them to professional medical care as soon as possible. In the case of untreated hyper or hypoglycemia, permanent impairment, coma and death can occur.



If the person is unconscious place them into the recovery position, on their side, and monitor their breathing and call for help. The doctor will most likely instruct you to obtain a complete set of vitals, including measuring their blood glucose level. The doctor may then advise you to administer Glucagon. It is used when seizures occur in an insulin user who is unable at that point to help themselves or if they become unconscious. Glucagon will facilitate the release of stored glucose back into the bloodstream, thus rapidly raising blood glucose levels.



To check a person’s blood glucose level, you need a Blood Glucose Meter or glucometer.

This inexpensive ($10-$100) medical device is used to determine the amount of glucose in someone’s blood. This is a must-have for every ship’s first-aid kit, and knowing how to use one is also important. I often include using the glucose meter as part of my onboard first-aid classes.



To check a patient’s blood sugar, first wash your hands and put on medical gloves and glasses. Remember to always wear personal protective equipment (PPE) when touching blood or other bodily fluids. If possible, ask the patient to wash their hands as well.



Wipe one of the patient’s fingertips with an alcohol prep pad and wait until the alcohol evaporates. (Some of the newer monitors use the forearm, thigh or fleshy part of the hand to take the test.)

Insert a test strip into the glucose meter. Use the lancing device (lancet) on the side of the fingertip to get a drop of blood. There are spring-loaded lancing devices that make sticking someone easier and less painful.



Gently squeeze or massage the finger until a drop of blood forms. Touch and hold the edge of the test strip to the drop of blood, and wait for the result.



The blood glucose level should appear on the meter’s display. Report these readings to your medical service provider and keep a record. You may be asked to administer the test again.  Keeping a record makes it easier for you and the doctor to establish a good treatment plan.

Some things to keep handy for your glucometer.

1. Make sure you keep batteries in stock that fit your glucometer.

2. Lancets come in different thicknesses. The higher the number, the finer the lancet. A 22-gauge lancet is thicker and may hurt more than a 30-gauge lancet.

3. Always dispose of your lancets in a puncture-proof container, such as sharps box. If one is not available, use a laundry detergent bottle with a screw-on cap to prevent needle-stick accidents. In the United States, many hospitals, fire departments and pharmacies have “sharps drop off” programs where you can bring your container when it is full.

4. Train all crew how to use the glucometer. Include the glucose meter as part of your annual training and when new crew are hired on to make certain they have the opportunity to train on this device.

 

Keith Murray, a former firefighter EMT, owns The CPR School, a first-aid training company. He provides onboard training for yacht captains and crew and sells and services AEDs. Contact him at 877-6-AED-CPR, 877-623-3277 or www.TheCPRSchool.com. Comments on this column are welcome at editorial@the-triton.com.

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