Diabetes and First Aid

[blueseal]

HI all,

I am an officer with a local Boys Brigade group in WA. This term we are running First Aid Focus (http://www.ambulance.net.au/firstaidfocus/index.htm) which is being run by one of the parents (who is a Paramedic). I have been asked to run a short session in relation to Diabetes. He will cover things from a Paramedic's perspective and I will be covering it from a Diabetics perspective.

Would be interested in finding out what people think are the hot topics that should be covered in relation to Diabetes. The audience is about 20 young boys from about 11 through to 18.

Thanks in advance

Andrew Sidebottom

Note: please share your ideas about what kind of things could be covered from a person with diabetes point of view i.e. how you would like to be treated by someone giving first aid, NOT medical advice for responding to a diabetes emergency. Kezza, for the mods.

[Topcat]

If I am in need of attention from Ambos I would prefer to be treated at the scene rather than taken to hospital, if I am still conscious. Once I am driven away it has implications on my ability to hold a drivers license which is unfair (I feel) if the cause for the call out was, for example, due to a Hypo whilst exercising, ie. cycling.

When I am severely hypo I can be disoriented and a little incoherent, although I am not aggressive I become non-compliant, so gentle persistent persuasion is required to get me to treat the cause, ie. take some form of glucose. Although it is obvious it does not make sense to me to consume glucose etc when I am well into the symptoms, or when I have proceeded past them at which point I am close to loosing my vision and greying out.

If I am mildly hypo and seem disoriented or 'not with it' I am quite capable of treating myself and do so unless it is a rare occasion with nothing available.

On the three occasions where people have helped me over the last 8 years, the first was when I had forgotten my 'kit' when I left for work and of course the nature of the universe demanded that a hypo was inevitable, a work mate noticed me walking erratically and grabbed the nearest thing available which happened to be an iced chocolate donut, yum! Other than the treatment choice I appreciated his help and concern. The second occasion was whilst doing Yoga which can have a dramatic effect on my BGLs, it was pre insulin pump and once lantus is injected it is hard to extract, my teacher noticed my eyes and pallor, plus the fact I was no longer following along but simply standing stupidly, she convinced me to eat JBs and placed me into a Yoga rest pose for the remainder of the session. I felt really stupid but appreciated her assistance. The third was after a long international flight and extended delays with US customs and immigration on arrival at Philadelphia. As we were being driven away my wife kept saying I should eat something and I kept arguing I was fine, eventually the symptoms hit me and we had to ask to be taken to a store as we only had nuts left. I did not recognise the symptoms but she noticed my eyes and skin and knew.

I have never progressed to a coma or seizure so cannot even suggest what I would be like.

Politeness, patience, perseverance and even empathy are always appreciated by me. As an occupational First Aider in the work place, these attributes and a knowledge of the symptoms and treatment protocols are what I endeavour to bring to a casualty also.

All the best with the group session, I think it is a good idea.

[kaito]

I second TC's comments about being persistent and patient - I find that hypo-me (my alter ego) is incredibly stubborn!! She doesn't do anything she doesn't want to do :) - and yes, it is like another personality within me that only comes out when hypo.

I've only had one coma requiring an ambo/trip to hospital, but that was 10 years ago, when I was 13. So I don't remember too much, but the biggest thing was the shock and confusion when I was coming to - last I remembered, I was in my Geography class at school, not in the back of an ambulance. So I think it's worth mentioning that to the group, I was absolutely terrified - what happened in this big gap in my memory?? And losing control, of your self, of the situation, and of your health - when I do need assistance (even if it's minor) there is that feeling of shame that I couldn't handle it myself - but everyone sees that differently I guess. There's also the fear of blame - I often would rather not go to the hospital (with my parents' support) because when you get there, often the doctors give you the "bad diabetic" spiel, and can't just accept that every now and then, s*** happens!! I would much rather learn from my mistakes and move on. So sometimes there is that fear to contend with too, but once again it's very individual.

So I think a lot of reassurance, patience, etc is needed in that first coming-to phase. Answering their questions, reassuring them that the situation is under control. I was more concerned over what I'd done with my school books, as I had them before I passed out - but thankfully some of the older students found them strewn across the school yard, and gave them back to me later - such kindness :) It's those sorts of things that a paramedic might not see as a big problem, but the patient might - it could be something as simple as "did I feed the cat?"

Hope the group goes well :)

[Jen (nli)]

I also agree with what Kaito and TC said.

That 'coming to' confusion is very hard. I've been treated by paramedics twice (once when pregnant, and one about three months after I'd had my daughter). First occasion I woke up and saw these two strange people in my room wearing really funny clothes, I thought they were from the Starship Enterprise... then I was convinced I was being abducted by aliens. It was terribly scary but also... quite funny at the same time! ... but I also felt very, very embarrassed. Even when thinking one could be being abducted by some star trek alien, I felt very embarrassed that it had all come to this. And the second time, I twigged they were ambos but was so incredibly glad my husband convinced them I didn't need to go to hospital. For all the reasons mentioned above.

So yes, persistent, gentle and understanding that although we're a bit mucked up when hypo, we may quite 'discombobulated' - so some sensitivity around that may be required. For example, trying to give the person some privacy could be helpful. That may not be your job but I think it is important.

[Emmalou]

Hey,

I think it is great that you are doing this focus group. Before I was diagnosed with D no one in my family (including me) or anyone in my friendship group had any clue about type one D. So I think educating people about it is great!

If I ever needed help from a first aider or an ambo for diabetic reasons I would really appreciate it if they didnt make me feel like I had caused them an inconvenience and been a pain in the but! So I guess for them to treat me with understanding. When ever I have hypos around friends, at work or at college I feel like I am causing a great inconvenience to the people around me even though i dont ask for their help. I think it is just that I feel as though I am causing them to shift their attention to me.

I know that is probably a little bit dumb because I obviously dont have hypos on purpose and they can just happen sometimes. So it would make me feel a bit better if friends and work mates acted a bit more understanding when it happens instead of like I am trying to get off work for ten minutes or sit down a bit longer!

[tantan]

I think it's important that they have a bit of an understanding of diabetes from a physiology point of view.

I remember asking my older sister (who I had always suspected was a bit clueless about diabetes) once what she would do if she found me fitting on the floor (assuming she didn't call an ambulance first), and she said, "Give you insulin?". Erm, no, don't think that would help. However, I think it illustrates what type 1 diabetes is in a lot of the general public's minds. They think type 1 diabetes = insulin, therefore, anything wrong with type 1 diabetic = must need insulin.

So essentially, I think understanding diabetes from both the 'not enough insulin' and 'too much insulin' perspective is useful. Understanding how this happens in a non-diabetic would help with understanding how it happens in a diabetic.

But you've probably already got this covered! :-)