Diabetes (cont.)

When to Seek Medical Care

If you someone you know are not known to have diabetes but are having any symptoms that suggest diabetes or concern you in any way, make an appointment to see a healthcare provider as soon as possible. When you make the appointment, tell the operator that you are concerned about diabetes. He or she may make arrangements for blood sugar testing before the appointment.

If the patient is known to have diabetes, call a healthcare provider right away if any of the following apply:

• The patient is experiencing diabetes symptoms. This may mean that your blood sugar level is not being controlled despite treatment.
  
  
• The patient's blood sugar levels, when tested, are consistently high (more than 200 mg/dL). Persistently high blood sugar levels are the root cause of all of the complications of diabetes.
  
  
• The patient's blood sugar level is often low (less than 60 mg/dL). This may mean that management strategy is too aggressive. It also may be a sign of infection or other stress on the system such as kidney failure, liver failure, adrenal gland failure, or the concomitant use of certain medications.
  
  
• The patient has an injury to the foot or leg, no matter how minor. Even the tiniest cut or blister can become very serious in a person with diabetes. Early diagnosis and treatment of problems with the feet and lower extremities, along with regular diabetic foot care, are critical in preserving the function of the legs and preventing amputation.
  
  
• The patient has a low-grade fever (less than 101.5°F). Fever is a sign of infection. In patients with  diabetes, many common infections can potentially be more dangerous for them than for other people. Note any symptoms, such as painful urination, redness or swelling of the skin, abdominal pain, chest pain, or cough, that may indicate where the infection is located.
  
  
• The patient is nauseated or vomiting but can keep liquids down. The healthcare provider may adjust medications while the patient is sick and will probably recommend an urgent office visit or a visit to the emergency department. Persistent nausea and vomiting can be a sign of diabetic ketoacidosis, a potentially life-threatening condition, as well as several other serious illnesses.
  
  
• The patient has a small sore (ulcer) on the foot or leg. Any non-healing sore or ulcer on the feet or legs of someone with diabetes needs to be seen by a medical professional right away. A sore less than 1 inch across, not draining pus, and not exposing deep tissue or bone can safely be evaluated in a healthcare provider's office as long as the patient does not have fever and their blood sugar levels are in control.

When you call a healthcare provider, tell the operator that you or someone you know has diabetes and are concerned.

• The patient will probably be referred to a nurse who will ask questions and make a recommendation about what to do.
  
  
• Be prepared for this conversation. Have a list of medications, medical problems, allergies to medicines, and a blood sugar diary handy by the phone.
  
  
• The nurse may need any or all of this information to decide both the urgency of the patient's condition and how best to recommend treatment for the problem.

Diabetic emergencies

The following situations can become 911 medical emergencies and warrant an immediate visit to a hospital emergency department.

• The person with a severe diabetic complication may travel to the emergency department by car or ambulance.
  
  
• A companion should go along to speak for the person if the person is not able to speak for himself or herself with the emergency care provider.
  
  
• Bring a list of medical problems, medications, allergies to medications, and the blood sugar diary to the emergency department. This information will help the emergency care provider diagnose the problem and treat it appropriately.

The following are signs and symptoms of diabetic complications that warrant emergency care.

• Altered mental status: Lethargy, agitation, forgetfulness, or just strange behavior can be a sign of very low or very high blood sugar levels.
  
  
  • If the person is a known diabetic, try giving him or her some fruit juice (about 6 ounces) or cake icing if the person is awake enough to swallow normally without choking. Avoid giving things such as hard candy that can lodge in the throat. The healthcare provider can prescribe glucose wafers or gels that melt under the tongue.
    
    
  • If the person does not wake up and behave normally within about 15 minutes, call 911.
    
    
  • If the person is not a known diabetic, these symptoms can be signs of stroke, drug intoxication, alcohol intoxication, oxygen starvation, and other serious medical conditions. Call 911 immediately.
  
  
• Nausea or vomiting: If the patient is known to have diabetes and cannot keep food, medications, or fluids down at all, they may have diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic syndrome, or another complication of diabetes.
  
  
  • If the patient has not already taken the latest insulin dose or oral diabetes medicine, do not take it without talking to a medical professional.
    
    
  • If the patient already has low blood sugar levels, taking additional insulin or medication will drive the blood sugar level down even further, possibly to dangerous levels.
  
  
• Fever of more than 101.5°F: If the primary healthcare provider cannot see the patient right away, seek emergency care for a high fever if they are diabetic. Note any other symptoms such as cough, painful urination, abdominal pain, or chest pain.
  
  
• High blood sugar level: If the patient's blood sugar level is more than 400 mg/dL, and the primary healthcare provider cannot see them right away. Very high blood sugar levels can be a sign of diabetic ketoacidosis or hyperosmolar hyperglycemic nonketotic syndrome, depending on the type of diabetes you have. Both of these conditions can be fatal if not treated promptly.
  
  
• Large sores or ulcers on the feet or legs: If the patient has diabetes, a non-healing sore larger than 1 inch in diameter can be a sign of a potentially limb-threatening infection.
  
  
  • Other signs and symptoms that merit immediate care are exposed bone or deep tissue in the wound, large areas of surrounding redness and warmth, swelling, and severe pain in the foot or leg.
    
    
  • If left untreated, such a sore may ultimately require amputation of the limb.
  
  
• Cuts or lacerations: Any cut penetrating all the layers of skin, especially on the legs, is a potential danger to a person with diabetes. Proper wound care, although important to anyone's recovery, is especially important in diabetics to assure good wound healing.
  
  
• Chest pain: If the patient is diabetic, take very seriously any pain in the chest, particularly in the middle or on the left side, and seek medical attention immediately.
  
  
  • People with diabetes are more likely than non-diabetic people to have a heart attack, with or without experiencing chest pain.
    
    
  • Irregular heartbeats and unexplained shortness of breath may also be signs of heart attack.
  
  
• Severe abdominal pain: Depending on the location, this can be a sign of heart attack, abdominal aortic aneurysm (widening of the large artery in the abdomen), diabetic ketoacidosis, or interrupted blood flow to the bowels.
  
  
  • All of these are more common in people with diabetes than in the general population and are potentially life-threatening.
    
    
  • Those with diabetes also get other common causes of severe abdominal pain such as appendicitis, perforated ulcer, inflammation and infection of the gallbladder, kidney stones, and bowel obstruction.
    
    
  • Severe pain anywhere in the body is a signal for timely medical attention.

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