Every yacht should have a glucometer and know how to use it

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 levels. To do this, you will 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.  Generally several of the crew volunteer to be the patient and several others volunteer to be the medical person performing the test.

Many people, when reading this article, are thinking that diabetes is not the common, but you are wrong. The American Diabetes Association estimates there are 29.1 million people in the U.S. that have diabetes.  That is over 9.3 percent of the U.S. population.

The World Health Organization (WHO) defines Diabetes as 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. People with diabetes may develop serious complications such as heart disease, stroke, kidney failure, blindness, and premature death.

DIABETES FACTS (from WHO)

•        More than 220 million people worldwide have diabetes.
•        In 2012, an estimated 1.5 million people died from diabetes.
•        Diabetes was the seventh leading cause of death in the United States in 2010, based on the 69,071 death certificates in which diabetes was listed as the underlying cause of death.
•        In 2010, diabetes was mentioned as a cause of death in a total of 234,051 certificates.
•        Almost 80 percent of diabetes deaths occur in low- and middle-income countries.
•        Almost half of diabetes deaths occur in people under the age of 70 years
•        55 percent of diabetes deaths are in women.
• Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use can prevent or delay the onset of diabetes.
•        In 2010, about 73,000 non-traumatic lower-limb amputations were performed in adults aged 20 years or older with diagnosed diabetes.
•        About 60 percent of non-traumatic lower-limb amputations among people aged 20 years or older occur in people with diagnosed diabetes.

How Do I Check A Patient’s Blood

1.     First, wash your hands and put on medical gloves and glasses. Remember, always wear your PPE – Personal Protective Equipment when touching blood or other bodily fluids.
2.     If possible, ask your patient to wash their hands as well.
3.     When the patient’s hand is dry, wipe the area you’ve selected with an alcohol prep pad and wait until the alcohol evaporates. Generally this is the finger tip. Note: Some of the newer monitors let you use your forearm thigh or fleshy part of your hand or another less sensitive place.
4.     Next, insert a test strip into your glucose meter.
5.     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.

6.     Gently squeeze or massage the finger until a drop of blood forms.
7.     Touch and hold the edge of the test strip to the drop of blood, and wait for the result.
8.     The blood glucose level should appear on the meter’s display.
9.   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.

Tips:

1.     Make sure you keep batteries in stock that fit your ships glucometer.
2.    Lancets come in different gauges – 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 container which is specifically for used medical needles. If one is not available, you can 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 make certain they have the opportunity to train on this device

RECOGNIZING DIABETIC EMERGENCIES – If the person is aware of their condition, they may be able to tell you what is wrong and how you can assist them. However, they may be unaware of the disease or symptoms may have progressed to the point of confusion. Some signs and symptoms may include dizziness, drowsiness, rapid breathing, lack of coordination, rapid pulse, sweating with skin cold to the touch, weakness, shaking, headache, irritability, bizarre or combative behavior, nervousness and they may have a fruity odor to their breath.

Symptoms may be similar to those of Type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen. Until recently, this type of diabetes was seen only in adults but it is now also occurring in children.

EMERGENCY DIABETES TREATMENT – If you know that 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 using a glucometer. 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.

If you would like to learn more about diabetes both the American Diabetes Association and The World Health Organization are excellent sources for information.

Keith Murray, a former Florida Firefighter EMT, is the owner of The CPR School, a mobile training company that provides shipboard CPR, AED and First Aid training throughout Florida.  In addition to training, The CPR School sells and services AEDs – automated external defibrillators.  Contact The CPR School at +1-561-762-0500 or Keith@TheCPRSchool.com. Comments on this column are welcome at editorial@the-triton.com.