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When Should A Diabetic Go To The Hospital

When To Go To The Hospital For Leg Pain

A Trip to the Emergency Room – Life with Type 1 Diabetes Day 1

When you are on the go and being pulled in so many different directions, sometimes it is impossibly hard to look after yourself. And by look after yourself, I mean tend to your general healthwhatever that may be. Granted, we must be judicious with what we choose to check out and how much time we spend checking it out, and it can be a bit difficult to discern whether a particular pain is hospital worthy or not. Leg pain can be some of the hardest pain to judge as it pertains to severity and whether or not you should pay a visit to the hospital. Here we intend to inform you on the physical cues to look out for concerning your leg pain and well also show how CBD can be used to thwart some of that unwanted pain.

Low Blood Sugar Avoid The Emergency Room

How to recognize and treat severe hypoglycemia quickly with emergency glucagon and avoid a trip to the hospital.

When you have diabetes, life can often feel like a juggling act to keep your glucose levels within your target range. Staying on top of your diabetes management is essential, but you may still face unpredictable and sudden swings in glucose levels due to medications, lifestyle , or illness. Hypoglycemia is when glucose values fall below 70 mg/dl as a result of too much insulin in the body for what your body needs at that time. When this occurs, your cells lack the glucose they need to produce energy.

There are three levels of hypoglycemia: level 1, glucose values fall below 70 mg/dL level 2, glucose levels drop below 54 mg/dL and level 3, referred to as severe hypoglycemia, which occurs when glucose levels are so low that you experience changes in thinking and reasoning and need support from others.

You should always treat lows right away, whether your blood sugar is below 70 mg/dL or trending toward that number. If your glucose levels drop below 54 mg/dl, you must act immediately to raise your blood sugar. If not treated quickly, severe hypoglycemia can occur and this can be very dangerous.

What are the signs of dangerously low blood sugar?

  • Shakes, sweatiness, and elevated heart rate

  • Hunger and weakness

  • Seizures

  • Loss of consciousness

  • For a list of common symptoms of low blood sugar, click here.

    How to treat severe lows with emergency glucagon

    Patients With Undiagnosed Pre

    Of the 23.6 million Americans with diabetes in 2007, 5.7 million were unaware they had the disease. Additionally, 54 million Americans had pre-diabetes . Patients who present to the emergency department are at high risk for undiagnosed diabetes in one study, nearly four out of five patients in an urban emergency department met American Diabetes Association criteria for diabetes screening.

    The diagnosis of diabetes requires testing performed on two separate occasions unless unequivocal hyperglycemia is present. Patients with unequivocal signs of hyperglycemia such as polyuria, polydipsia, nocturia, or acidosis are likely to need hospital admission, where further testing may be performed. Using an insulin protocol, treatment of hyperglycemia should ideally begin before admission and should not be delayed by confirmatory testing. This requires close and clear communication and collaboration between the Emergency Physician and the Hospitalist.

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    Glycemic Control After Hospitalization

    There is vast discrepancy among Hospitalist regarding glycemic management goals throughout the US. This is despite data supporting improved patient outcomes and hospital stays. Recently studies have suggested that tight glycemic control in the hospital setting may lead to an increase in mortality due to hypoglycemia. However, the level of glycemic control in those studies was much tighter than recommended in the AACE/ADA guidelines for random blood glucose goals. It is common for Hospitalists to allow blood glucose levels to fluctuate during a patients hospital stay. The traditional Hospitalist training, primarily in an Internal Medicine residency program, often consists of treating diabetic patients with a regular insulin sliding scale. Diabetes management was not thought to be an issue of critical importance until blood sugars consistently were above 300 mg/dl or acidosis reared its head. The nature of Hospital Medicine is to be involved in all aspects patient care. Glycemic control should be viewed differently in lieu of data linking improved patient outcomes and eugylcemia.

    The American Association of Clinical Endocrinologists and the American Diabetes Association published their revised consensus statement on the inpatient standards for glycemic control in 2009. Overall their guidelines had remained consistent with slight alterations in overall blood sugar levels. The following is a summary of those recommendations:

  • Non-critically ill patients

  • How Common And Serious Is Diabetes

    DKA Rate During Hospitalization is Too High

    The National Diabetes Statistics Report produced the following key findings:

    • 34.2 million Americans have diabetes
    • 88 million American adults have prediabetes
    • New diagnosed cases of type 1 and type 2 diabetes among US youth is on the rise

    Diabetes is a serious condition that can lead to severe complications that may result in disability or even death.

    Possible complications from diabetes include:

    • Cardiovascular Disease
    • Depression

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    How Can I Tell If I Have One

    An ulcer on your foot does not always mean that you have an infection. Infections can cause constant pain, redness around an ulcer, warmth and swelling, pus, or an ulcer that does not heal. You should see your doctor as soon as possible if you have any of these signs.

    You should also see your doctor or go to the hospital right away if you have fever or chills, have red streaking or redness spreading out from a wound, or if blood is constantly draining from the wound. These can be signs of a very bad infection.

    You Need A Care Team Including Diabetes Nurse Educators Nutritionists And Possibly Other Specialists

    Just receiving a diagnosis and learning about diabetes often is not enough to help you manage your disease. Seeing a specialist will connect you with an entire diabetes care team whose membersnurse practitioner, dietician, pharmacist, educator, and exercise physiologistbring unique areas of expertise to help individualize your care according to your specific needs.

    While primary care doctors provide good treatment for people with diabetes, if managing your condition feels complicated and unmanageable, you might want to see a specialist. Endocrinologists and diabetes care teams can provide you with their expertise, tools, and resources specific to your individual symptoms and condition. Exploring all your options will help you determine the best management plan and achieve the highest quality of life.

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    What Are The Risks Of Hyperglycemia

    Hyperglycemia can be a sign that your body isnt getting enough insulin. It is normal for patients with T1D to get hyperglycemia, and most of the time this is simply treated with insulin. If the body does not have insulin for approximately 8 hours, you could develop a condition called diabetic ketoacidosis, or DKA.

    In DKA, your body breaks down fat for energy because it doesnt have enough insulin to use the sugar in your blood. This produces chemicals called ketones, which make your blood more acidic.

    DKA is dangerous. Too much acid in your blood can make you pass out or even cause death.

    Treatments For Diabetic Ketoacidosis

    Diabetes Clinic Check-up at Boston Children’s Hospital

    DKA is usually treated in hospital.

    Treatments for DKA include:

    • insulin, usually given into a vein
    • fluids given into a vein to rehydrate your body
    • nutrients given into a vein to replace any you’ve lost

    You’ll also be closely monitored for any life-threatening problems that can happen, such as problems with your brain, kidneys or lungs.

    You can leave hospital when you’re well enough to eat and drink and tests show a safe level of ketones in your body. It’s common to stay in hospital for around 2 days.

    Before leaving hospital, ask to speak to a diabetes nurse about why you got DKA and what you can do to stop it happening again.

    Page last reviewed: 01 May 2020 Next review due: 01 May 2023

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    Managing Your Diabetes Devices

    If you are using an insulin pump, talk to your diabetes team about how to best manage hyperglycemia. In general, be sure to check your pump first. Make sure all parts are connected and working correctly. Check your bolus history and temporary basal rate. Also check your insulin to make sure it has not expired or gotten too warm.

    If you use a CGM, try not to react to it too often. You might be tempted to give another dose of insulin too soon, before the first one finishes working, which is known as stacking insulin this can cause low blood sugar .

    Heart Attack And Type 2 Diabetes Emergencies

    Heart disease rates are up to 4 times higher among adults who have diabetes than among those who do not. This is because diabetes causes damage to the nerves and blood vessels, along with arteries, which supply the heart with blood.

    Some of the symptoms of a heart attack include:

    • Chest pain such as tightness, or a feeling of pressure or squeezing. The pain or discomfort can come and go, as well a being constant.
    • Stomach pain, which can feel like heartburn.
    • Anxiety, feelings like youre having a panic attack although you dont know why.
    • Feeling short of breath. This can happen before you develop any chest discomfort. Alternatively, you may not feel any chest pain.
    • Nausea and vomiting.
    • Sweating, especially with skin that feels cold or clammy.

    Getting regular cardio tests can help keep you informed on the condition of your heart, but if you experience any of the above you should call 911 for emergency care immediately.

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    When To Call The Doctor

    Being sick increases the risk of more serious emergencies seen with diabetes.

    • Blood sugar higher than 240 mg/dL for more than 1 day
    • Moderate-to-large ketones with your urine tests
    • Vomiting or diarrhea for more than 4 hours
    • Any severe pain or chest pain
    • A fever of 100°F or higher
    • Trouble moving your arms or legs
    • Vision, speech, or balance problems
    • Confusion or new memory problems

    If your provider does not call back right away, you may need to go to the emergency room. This is particularly important if you are vomiting or have diarrhea for more than 4 hours.

    What Is A Diabetic Coma

    Thousands of diabetics have been

    Diabetic coma is a life-threatening emergency that can happen to you if you have diabetes. In a diabetic coma, youre unconscious and unable to respond to your environment. Youre either suffering from high blood glucose or low blood glucose . You need immediate medical attention if you go into a diabetic coma.

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    Planning For Sick Days

    Your body releases stress hormones when you are sick, which can cause hyperglycemia. Keep taking your insulin and other diabetes medications, even if you are throwing up. If you have ketones and your blood sugar is above 240 mg/dL, call your doctor. They might also want you to call if:

    • You have diarrhea that lasts more than 6 hours
    • You are throwing up
    • You have a high fever or trouble breathing
    • You feel very sleepy or confused

    Continue checking your blood sugar levels and keep track of the results.

    A Blood Sugar In The 300s Is Dangerously High And All Diabetics Need To Recognize When Its Time To Rush To The Emergency Room When Their Glucose Levels Soar Into An Unacceptable Range

    Normal non-fasting blood sugars are acceptable below 150, preferably 80-120, says Yvette McQueen, MD, emergency medicine physician and CEO of MedQueen LLC, through which she offers travel medicine, urgent care and nutritional consultations via telemedicine to individuals, executives and travel groups.

    Long-time diabetes or hard to control diabetes may have blood sugars in the 300s, continues Dr. McQueen. They will manage it at home with medications, and the blood sugar will reduce.

    When a Blood Sugar in the 300s Means a Trip to the ER

    Dr. McQueen explains that when blood sugars are in the 300s and they have symptoms , they should definitely come to the emergency department.

    Two Types of Diabetes 300sType 1. The pancreas does not produce, or does not produce enough, of the hormone insulin.

    Type 2. The pancreas secretes enough insulin, but the insulin receptor sites on cells are impaired.

    Shutterstock/Maya Kruchankova

    Type 1 diabetics can easily bring their blood sugars down with insulin, says Dr. McQueen.

    So people who have hard to control sugars will wear an insulin pump that steadily gives the body insulin.

    Type 2 diabetics glucose can be reduced by pills or insulin injections usually the glucose input into their body will cause it to spike. Exercise as well will bring down the glucose. 300s

    The concern for high blood sugars is the bodys reactions, continues Dr. McQueen. The body is a fine-tuned machine and likes to have levels steady.

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    When You Are Discharged

    Before you leave the hospital, make sure that you:

    • have written instructions about changes in your dosage of medication or insulin injections and any new medications or treatments
    • have instructions about meal plans and activity levels once you are home
    • know how often to check your blood sugar level and what the expected levels should be
    • know what symptoms to watch for once you leave the hospital and know who and when to call for medication adjustments or other medical problems
    • schedule a follow-up appointment to review your progress and your diabetes management.

    Guide To Being Hospitalized

    “Management of Diabetic Ketoacidosis” by Michael Agus, MD for OPENPediatrics

    Being admitted to the hospital, whether its planned or an emergency, can be stressful. Preparation beforehand will help ensure your diabetes is well managed throughout your stay.

    First and most importantly, be knowledgeable about your own health and your own needs. Be prepared to speak up clearly and concisely when you are confused or worried about anything that is happening. Being prepared with up-to-date information about your medical history will help you feel less anxious. It will also help the hospital staff take better care of you, and hopefully have you on the mend and on your way home as soon as possible.

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    You Are Having Complications Or Difficulty Managing Your Diabetes

    You should definitely see a specialist if you have developed complications. Diabetes typically causes problems with the eyes, kidney, and nerves. In addition, it can cause deformity and open sores on the feet.

    Diabetes complications only get worse with time, and can cause you to miss out on quality of life. In addition, you should see a specialist if you are having frequent low blood sugars or have ever had severe low blood sugar or diabetic ketoacidosis.

    Write Down Important Information To Take With You

    Its easy to forget important information, especially if you are worried or ill. Before entering the hospital, spend time making a list for each of the following:

    • your medical history, including food or drug allergies and previous medical procedures or surgeries
    • all the medication you are currently taking, including:
    • diabetes medications: brand name, strength, dosage, times to be taken
    • if you take insulin: dosage , how often, times to be taken
    • other prescription medications
    • vitamins or herbal remedies
  • the meal plan you follow at home.
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    When To Get Medical Help

    Go to your nearest A& E immediately if you think you have DKA, especially if you have a high level of ketones in your blood or urine.

    DKA is an emergency and needs to be treated in hospital immediately.

    • your blood sugar or ketone levels are high or getting higher over time, but you do not feel unwell
    • you feel unwell but your blood sugar or ketone levels are normal or are only a little bit higher than usual

    If you cannot contact your care team or GP, call your local out-of-hours service or NHS 111 for advice.

    How Does Hyperglycemia Happen

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    Insulin is a hormone that lets your body use the sugar in your blood, which comes primarily from carbohydrates in the food that you eat. Hyperglycemia happens when your body has too little insulin to use the sugar in your blood.

    People with type 1 diabetes can have episodes of hyperglycemia every day. Although this can be frustrating, it rarely creates a medical emergency. Not taking enough insulin can lead to hyperglycemia .

    Other things that can cause hyperglycemia include:

    • Caffeine
    • Having trouble seeing or concentrating
    • Experiencing stomach pain, nausea, or vomiting
    • Having sweet-smelling or fruity breath
    • Cuts or sores that do not heal, infections, and unexplained weight loss may also be signs of long-term hyperglycemia.

    If you notice any of these symptoms, you should check your blood sugar. If your blood sugar is very high, you should also test for ketones in either your blood or urine.

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    How Is It Treated

    Antibiotics are usually used to treat the infection. If you have an infection that has moved into the deeper layers of the foot, such as the muscle or bone, you will be sent to the hospital and given antibiotics through an IV. Any dead or infected tissue will be removed. Some people with poor circulation may need surgery to improve blood flow to the foot and to avoid amputation.

    The wound should start to heal in two to three days. Your doctor will check the wound at least once a week to make sure it is healing. You may need a nurse to help you at home with wound care. You may also have to wear a cast or special shoes to protect the wound area. You should stay off your foot as much as possible and keep your foot raised.


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