Very good points. It is imperative that first-responders know the difference between T1 and T2, insulin dependent and non-insulin dependent. My biggest fear is that I will be in a car accident or something and no one will understand that as a T1, I require insulin.
First responders should also understand that people on insulin pumps can end up really high if they are disconnected from their pump in an accident or something. If I am in a car accident and my pump gets disconnected, I will need insulin administered immediately upon arrival to the hospital.
So, in addition to understanding the different between high and low BGs, first responders should also know the different forms of diabetes and what they mean.
While that graph is scary, the DCCT study is now nearly 20 years old. Diabetes care and technology has changed dramatically in that time. It would be great if there could be another comprehensive study done today. The fact that things are improving is demonstrated by the dramatic increase in lifespan recently reported for T1 diabetics.
And as Zoe points out, variability (standard deviation) is a big factor too. You could have someone with a high A1c that bounces way up and down and has lots of hypos, while someone with a lower A1c and less variability rarely does.
OK, I might have stretched it a bit with those numbers... in both allergy patients and diabetic patients, the point is there are risks, and in both cases you don't have to be diabetic to be hypoglycemic and you don't have to have severe allergies to have anaphylaxsis - but the risks are higher in those populations.
that "chance that they wold get them backwards" is basically why they teach always to treat for HYPO - then if no improvement look at other things. I'm not sure I really like that teaching, but I understand, if you are low, things can get serious pretty quick (for some people anyways)
I realized the same thing (of course, that was after my little freak out)... DCCT is really old news now, so much has changed, and fortunately, improved!
(it's just that the DCCT was pretty revolutionary in my time, and had huge effect on my D care, so I forget it's old news now - I was actually a DCCT participant way back when, sadly, just part of the control group - and they dropped contact with control 'folks when the study stopped, or so I was told)
Many good points have been made here but I think that we have to remember too that not everyone on insulin tests diligently so that probably contributes to some of the severe hypos that require ER treatment.
Also, I think everyone should be aware that the process of becoming hypo unaware sneaks up on you. I'm hypo unaware and can think back to the period of time where it slowly dawned on me that I was having unexpected lows with no symptoms. At first I was glad not to have those horrible symptoms and then it slowly dawned on me that it was a scary situation, definitely not a good thing.
As far as how fast a severe hypo can come on, I have experienced several in the last few years where I dropped from an in-range level to low 20's in a matter of minutes. I managed to avoid a call to 911 because I had glucagon at hand. I have a cgm though because I am hypo unaware and the cgm alerted me to the fall in time to react. Had I not had the cgm, I'm sure I would have been in the ER.
My insurance requires me to talk to a CDE ("health coach") and she questioned me about what precautions I take when I walk or exercise. I told her that I always carry my cell phone, glucose, my pdm for my pump, and my cgm...my pockets are full (I keep meaning to get a spibelt). The CDE said that most people on insulin that she speaks to do not take those precautions. I live in a hot, very humid climate and exercising outdoors is one of those things that can make my bg fall dramatically.
I think also with DKA, it can catch people unaware. I mean its sad to say, but this group here is really kinda the exception to the rule-how well so many of us keep an eye on things, test frequently, for us yes we should and very likely WOULD catch rising high's before they became problematic. Just as most of us probably would catch low's before they became very problematic as well. There are a lot of diabetics out there who dont test for a variety of reasons. Are unaware of what their a1c is, or quiet honestly just don't care. DKA is usually slower to occur, however when it does occur, or you are very close to being in DKA, you definately do need medical attention to quickly and safely get those numbers down.
I think for some of the medically uneducated population, who have either had a lack of good diabetic education, or once again, just aren't interested, a lot of signs of DKA could easily be mistaken for I've caught something and I'm just ran down. I think education is key. People really do need education on signs and symptoms to look for, what they mean, and how to treat.
All excellent points, Christy...sad, but true. Also important if developing education for the "general public". I forget over and over how atypical we are, even in developed countries, let alone developing ones where the money, technology and education just isn't there.
I find bad hypos really unpleasant! But rare as my sugars are usually quite high. Ive had several DKA admissions since having my first child and definitely think its more common. Very frightening. I thought I was having a heart attack. Not to mention the thirst. Ive found it hard to keep good control (had it since I was 2, now 21)
All fabulous points - I think, even as well aware and well controlled diabetics, throw yourself into an unknown, possibly emergency situation (say in a biking accident on a remote trail - bunch of people crash, multiple injuries, gonna be many hours before help arrives) and missing the signs of DKA seem entirely possible ... and if you have a pump, and it disconnected, and you don't get insulin, trouble, trouble, trouble
If a PWD is in convulsions or passes out, is it safe to assume that he is experiencing a hypo? I have only one experience of what I considered DKA. The symptoms were completely different. I felt terrible and threw up all day, but I did not become confused or lose consciousness. Is this typical? I was able to treat myself at home and did not go to the hospital.
1. I hate high glucose levels as they take longer to get under my required levels. 2. In 50 years, one ambulance trip to ER for a low (colloge--1972--long story.)
3. Except at diagnosis, never had a DKA episode. I check if over 200 but no problems.
I have had paramedics in my home for lows. They have been fantastic. I just wish they would help my husband also. It is hard for him.
Opinion--emphasize hypo care. It kills quickly and is not understood. Hyper is a lot more intense and requires immediate hospitilzation. The guy in the street cannot cure you with a candy bar or a soda.
(had it since I was 2, now 21)