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Insulin isn't something you need acutely. Insulin is used to treat _hyper_glycemia (blood sugar too high). This is a gradually developing condition, and someone
by JshWright 14y ago
Insulin isn't something you need acutely. Insulin is used to treat _hyper_glycemia (blood sugar too high). This is a gradually developing condition, and someone couldn't go from 'normal' to 'critically ill' over the course of a flight. EDIT: reading your description below regarding the stolen meds, this seems reasonable. He likely _was_ experiencing some symptoms of hyperglycemia even as you were boarding.
The most common type of 'diabetic shock' is _hypo_glycemia (blood sugar too low). The treatment for this is simply sugar (if the patient is conscious, they can take it orally, if they're unconscious, then they need an IV with Dextrose).
I suspect most airline medkits carry dextrose (the one mentioned in the article did). I would imagine many of them carry glucagon as well (glucagon can be injected into the muscle, which is quicker and easier than establishing an IV, and it signals the liver to release its glycogen stores (by breaking it down into glucose (sugar))).
I imagine insulin is very rare. It doesn't keep for terribly long, most types need to be refrigerated, and the most common use cases are for things that don't come on 'suddenly' (generally someone experiencing severe hyperglycemia has had symptoms for hours or even days).
- carbocation 14y agoDon't forget the two big hyperglycemic emergencies: diabetic ketoacidosis and hyperosmolar hyperglycemic state.
- JshWright 14y agoSure, but DKA and HHNK aren't generally sudden onset sorts of things. Usually there's been a few hours worth of symptoms leading up to them.
- carbocation 14y agoFrom joezydeco's follow-up comment from a few hours ago, it sounds like there was a window of concern for several hours before boarding the flight. At any rate, there was no mention of this being sudden onset. Just encouraging people on this site who don't have a medical background to understand that there are indeed emergencies due to hyperglycemia/hypoinsulinemia.
- cperciva 14y agoI'd still say that the most important thing there is to give fluids, not insulin. When you're seeing a new patient and don't have a medical history, it's impossible to know how sensitive they will be to insulin, and the last thing you want to do on a transatlantic flight is take them from hyperglycaemic to hypoglycaemic. Giving enough fluids will allow the kidneys to do most of the the critical fixing of blood chemistry. (I am not a doctor, but I am a diabetic who has experienced DKA.)
- carbocation 14y agoYes, I agree that one critical element of treatment is fluid resuscitation. I think that because the person who started this thread was talking about insulin, that has remained a subtext throughout the conversation. My goal in posting was to alert people to the fact that blood insulin/glucose emergencies include states on both extremes of the insulin/glucose spectrum. I didn't mean to imply anything about management.