aeromedical concerns with the diabetic patient presentation
Post on 05-Apr-2018
214 Views
Preview:
TRANSCRIPT
-
7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation
1/18
AeromedicalConcerns for the
diabetic patientTC4 AVMX 721
Sundaresan Maiyalagan
15thMay 2012
-
7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation
2/18
Content Overview
Introduction
Current definition and classification of Diabetes
Complications and its implications foraeromedical transfer
Aeromedical concerns with management ofblood glucose levels
General advice for passengers flying with
diabetes
-
7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation
3/18
Introduction
171 million people in the world with diabetes mellitus(DM) in the year 2000 and this is projected to increase to366 million by 2030
8.3 percent of the U.S. Population
In Mauritius the prevalence is as high as 15% (2004survey)
Multiple associated complications and co-morbidities
Heterogeneous population with a varied range ofdisease spectrum
-
7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation
4/18
Current definition and classification
-
7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation
5/18
Current definition and classification
-
7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation
6/18
Complications and its Implications forAeromedical Transfer
Acute consequences of impaired glycemic control Hypoglycemia, Ketoacidosis and hyperosmloar non-ketotichyperglycaemic coma
Stiff Joint Syndrome and associate difficult laryngoscopy
Cardiovascular complications - Silent MI, Cardiomyopathy
Diabetic Sensory and Autonomic Neuropathy
Diabetic Retinopathy and Cerebral Complications
Diabetic Nephropathy
Impaired wound healing and immunity
-
7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation
7/18
Complications and its Implications forAeromedical Transfer
Diabetic Autonomic Neuropathy effect on various organsCardiovascularResting tachycardiaExercise intoleranceOrthostatic hypotension
Silent myocardial ischemia
GIEsophageal dysmotility
Gastroparesis diabeticorumConstipationDiarrheaFecal incontinence
-
7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation
8/18
Complications and its Implications forAeromedical Transfer
Diabetic Autonomic Neuropathy effect on various organs
GenitourinaryNeurogenic bladder (diabetic cystopathy)
MetabolicHypoglycemia unawarenessHypoglycemia-associated autonomic failure
SudomotorAnhidrosisHeat intoleranceGustatory sweatingDry skin
-
7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation
9/18
Complications and its Implications forAeromedical Transfer
Diabetic Autonomic Neuropathy effect on various organs
PupillaryPupillomotor function impairment (e.g., decreased diameter ofdark adapted pupil)
Argyll-Robertson pupil like phenomenon
RespiratoryImpaired response to hypoxia and hypercapnia
-
7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation
10/18
Aeromedical Concerns With ManagementOf Blood Glucose Levels
Oral Hypoglycaemic Drugs and Insulinadministration
Blood Glucose monitoring
-
7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation
11/18
Aeromedical Concerns With ManagementOf Blood Glucose Levels
Oral Hypoglycaemic Drugs and InsulinadministrationTiming
Maintaining bioactivity of insulinInsulin pumps and aeromedical transfer
Picture of the Minimed Paradigm 722 (Insulin pump device,
Medtronic)(A), with the continuous blood glucose monitor(C) and transmitter (D), and the infusion set (B).
-
7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation
12/18
Aeromedical Concerns With ManagementOf Blood Glucose Levels
Oral Hypoglycaemic Drugs and InsulinadministrationTiming
Maintaining bioactivity of insulinInsulin pumps and aeromedical transfer
(Bruce R King et al . Diabetes Care 34: 1932-33, 2011
The cartridge should only contain 1.5 ml of insulin
Disconnect the pump before takeoff At cruising altitude, take the cartridge out of the pump and remove air
bubbles before connecting After the plane lands, disconnect the pump and prime the line with 2
units. Then reconnect the pump.
During flight emergencies involving cabin decompression, disconnectinsulin pump.
-
7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation
13/18
Aeromedical Concerns With ManagementOf Blood Glucose Levels
Blood Glucose monitoring
Availability
Variability
Effect of altitude on glucometer performancePatricia L Brubaker. Adventure Travel and Type 1 Diabetes. Diabetes CARE 2005; 28 (10): 2563-72
Aircraft regulations regarding use of ContinuousGlucose Monitoring devices
-
7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation
14/18
General advice for passengers flying withdiabetes
Two blood glucose monitoring devices, with extrabatteries, packed in separate bags
Enough insulin, syringes, lancets, and test strips to lastthe entire trip
For pump users, enough pump supplies for the entiretrip, extra batteries, and supplies of long-acting insulin(ultralente or glargine) and regular or rapid-acting insulinanalog (lispro or aspart) and syringes for use in case of
pump malfunction or battery failure
Prescription medicines (including a glucagon emergencykit), for diabetes and other medical conditions
-
7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation
15/18
General advice for passengers flying withdiabetes
Simple carbohydrate sources, such as glucose tablets,gels, candy, and nondietetic soft drinks to relievesymptoms of hypoglycemia
Complex carbohydrate sources, such as breakfast bars,cheese crackers, granola bars, and trail mix to serve assnacks when meals are missed or delayed
Regular insulin or short-acting insulin analogs fortreating high blood glucose and for sick-day
management even if these are not part of the patientsregular regimen
Identification (diabetes identification card, Medic Alertnecklace or bracelet)
-
7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation
16/18
General advice for passengers flying withdiabetes
Insurance papers (Confirm before travel what medicalcoverage is available from the insurer in the event of amedical problem abroad.)
Medications for vomiting and diarrhea
A first aid kit, including analgesics, antibiotic andantifungal creams, bandages, sterile gauze, andadhesive tape
-
7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation
17/18
Conclusion
In conclusion, patients with DM are a heterogeneous
population, but there are key areas where the aeromedical
team must focus and be prepared with regards to type of
diabetes, the associated complications, management of
blood sugar levels and the effects of aeromedical transfer
on these areas in order to ensure a safe and effectiveaeromedical transfer of patients with diabetes.
-
7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation
18/18
Thank YouTC4 AVMX 721
Sundaresan Maiyalagan
15thMay 2012
top related