Pour some sugar on me

Drunks. Probably the most common job for ambulance crews across the UK. Alcoholics, Saturday night revellers that have had one too many… There are many reasons why a person night be drunk and incapable, but crews must be wary. Not only of the potential for an aggressive but also for misdiagnosis. Not everyone who appears drunk actually is drunk.

There have been jobs I was called to where we turned up and the patient was rolling around, cursing and swearing at onlookers, there was even the strong smell of spirits about them. But they weren’t drunk. The smell? Ketones. The problem? Diabetic Ketoacidosis.

Diabetes affects almost 4 Million people in the UK (approx figures, 2019). Many of those have it under control by their diet or by medication. Occasionally, or in some patients often, their blood sugar rises too high (hyperglycaemia). This can happen for many reasons, but whatever the reason, the results can be fatal. Excess levels of acid build up in the patient’s body and can cause organ failures. To onlookers the patient can seem, and smell, drunk. The only course of action an ambulance crew has in this situation is to take them to hospital where the patient’s blood sugar can be monitored and lowered in a controlled environment.

At the other end of the scale, diabetics can sometimes let their blood sugar drop below safe levels too (hypoglycemia). This too can be dangerous, but ambulance crews can do something more in this case. Initially, if the patient is conscious, there is a disgusting tasting gel that comes in tubes. In my day it was known, cleverly, as Hypostop. It usually did…what it said on the tube. In more severe cases where the patient may not have been quite so conscious, they carry a drug known as Glucagon. I’m not going into the chemistry here, if you want to know more details as to its function, there’s a lot of information on the Internet. Basically, it helps raise blood sugar levels. The only problem with the drug is that it needs to be injected into the patient’s arm or leg. Simple….you might think!

We had a few regulars in our area. People who didn’t control their blood sugar levels very well for various reasons. Two of them became quite aggressive when their blood sugar became low, one in particular. Ambulance crews have no ability to restrain a patient, and usually the police are called for such things if required, but in some circumstances there’s no time for that. We knew the drill, and we usually had the patient’s consent…afterwards, when they were stable. One of us would hold the patient down while the other injected the glucagon. We had a set routine and it worked well. Once the patients blood sugar began to rise, and they became more lucid, we’d give them some of the vile tasting gel and one of the family would make them some toast. They never went to hospital, there was no need, and we left on good terms.

An unwell diabetic incident can have many forms. Sometimes it can even look very much like a stroke. Yes, there are a lot of drunks out there, but I have been to many incidents where people have decided the patient is simply drunk and act in a very quite judgmental fashion. Important lesson No. 1 – never assume that what you see is caused by what you think it is. Ignorance is not an excuse for poor actions. Ambulance crews are trained to use the equipment they carry and diagnose based on their knowledge and experience. Leave them to do the diagnostics and treatment.