New trends in diabetes management

The box of syringes, pile of needles, and refrigerator or ice chest with insulin remain good clues to the presence of diabetes in your patient. EMS providers must recognize that not all diabetics--even type I, insulin-dependent diabetics--carry this paraphernalia. The insulin-delivery system may be the size of a beeper, a small pen or even an inhaler device. If the patient has an alteration of consciousness, the astute provider will search for these clues, check the blood glucose and treat appropriately. The availability of four classes of oral diabetic agents allows many type II diabetics to be treated without the use of insulin. EMS providers may see these agents used alone, in combination with other oral agents or with insulin. Important points to remember include the possibility of hypoglycemia with the sulfonylureas, lactic acidosis with metformin, and liver failure with the thiazolidinediones. The sulfonylureas and chlorpropamide, specifically, may provoke an Antabuse-like reaction when the patient drinks alcohol.