Hypoglycaemia

[Hombre]

Dear all,

I read in the Cabin Crew/"Doctor on Board" thread a suggestion that if a pax was suffering from hypoglycaemia the CC should give in the first instance a glass of water on the basis that the said CC knew it would work or was the best thing to do.

The thread poster/writer wasn't challenged on this point and as the thread is now locked I thought it worthwhile to point out that a glass of water would have no effect here - apart from reducing dehydration.

Depending on how severe the "hypo" is the best thing to do is give a sugar solution (preferably in still water) assuming the pax is still conscious. If the hypo is caught even earlier a mars bar or can of coke (not diet!) would be even better. The first check should of course be to see if the pax has a medical bracelet identifying them as diabetic, albeit in theory anyone can suffer from excessive low blood sugar.

Regardless, getting some sugar down them is the best solution and will have an almost immediate effect. Presenting symptoms of the hypo can be apparent drunkeness but (importantly) without the smell of alcohol.

Hope this is useful. Hope I don't sound too like your dad :ok:

[flybywire]

Hello Hombre!!

No, you do not sound like my dad, however the cabin crew in question was me, but if you read my post again I did not refer to hypoglycaemia but to hyperglycaemia, which is the exact opposite.

I would not give a sugary drink/snack to somebody suffering to hyperglycaemia, however drinking water is the best harmless thing they can do at that point, as it could dilute the amount of sugars in their bloodstream at that point.

I hope this clarifies the matter (and again, I am pretty sure I wrote HYPERglycaemia in the previous post!!)

Cheers!!!

FBW:)

[GANNET FAN]

Both and Hombre are correct in dealing with both symptoms. I was married to a diabetic and have a diabetic son and I've lost count of the number of times I have had to deal with hypos. It still scares the hell out of me. But my point is, would it not be a good idea to carry a Glucogon injection kit on board as part of the medical kit; or would the act of injecting a pax lead to all sorts of complications, legal and/or otherwise? This is a lifesaving method which is more reliable and quicker than trying to administer sugar in whatever form by mouth when the recipient can be in the throes of convulsions.

Just a thought.

[Pax Agent]

At BA we carry this but it is only for doctors use. However we carry Hypostop glucose gel which can be administered to an unconcious pax by massaging it into their cheek should no doc be avail.

[GANNET FAN]

Pax Agent, I havn't heard of the glucose gel; sounds like a good substitute. I do recall one doctor saying honey under the tongue was better than sugar. Either way I hope you don't come accros the hypo too often.
JC

[Pax Agent]

thanx alot....it is rather good. Its literally sugar suspended in a gel that is rubbed into their cheek and under their tongue with their head tilted to one side so as not to swallow the gel.

X

[flybywire]

Unfortunately hypoglycaemia is very common (had quite a few episodes over the years) but it is much easier to recognise (for us) than hyperglycaemia. We do carry insulin in the Medical Kit but it's something a doctor only can administer. The airline reccommmends to all diabetic people to carry their own insulin.

I encourage diabetic people to come and tell me if they need to eat at a different time, so that if they have taken their insulin before getting on board and need a snack as soon as they board I will try to accomodate that to avoid a nasty episode.

As Pax has also said we do carry Hypostop, which is a glucose gel that can be administered if a diabetic person goes unconscious due to hypoglycaemia. It's a gel that has to be rubbed into the person's cheek/under the tongue/inside the lip so that it can be absorbed very quickly. It is usually very good, I had to use it twice in BA and it worked very well both times.
Back to the original point though, I have checked my previous posts on the closed thread and Hombre, I was indeed talking about hyperglycaemia :8 so that's the proof that at least pregnancy hormones haven't completely eaten my brain cells (yet!) :ok:

[GANNET FAN]

I had considerable concern that my diabetic son when passing through security, would have his "jag kit" questioned, fair enough, or confiscated, disastrous. So in the end I told him just to keep it in his coat because the thought of having to try and explain to a security specialist about diabetes was too much to gamble with.

Has anyone had similar doubts or experience?

JC

[flybywire]

Hi Gannet, a doctor's certificate should be enough to clarify everything, provided the needles are contained in an appropriate container (like in some passengers' insulin kits I have seen on board before).

I also always stress that if people need to use the kit on board not to leave needles in the toilet bins (for obvious reasons it is considered a hazard) so ideally the kit should contain a hard case for disposing of it as well.

Another tip: some aircraft (especially short haul ones) do not have a fridge and crew might be unable to keep you medicines fresh for this reason (or for company procedures) so make sure you know how long your medicines can survive outside a fridge too! Most insuline types I have seen clearly state you can keep them at room temp for about 24 hours but yet I am not a diabetic therefore I can only report what I see on board.

FBW:ok:

[GANNET FAN]

FBW, good advice. I forgot about the simple expediant of a doctor's cert! As a matter of fact the needles are reusable and the modern ones are only about half an inch and are attached to what looks like a fat pen.
And don't get the disease, please, it aint fun!
JC

[Hombre]

FBW, I stand corrected you did indeed refer to "hyper"; my mistake.

Hyperglycaemia is indeed a different kettle of fish and thankfully very uncommon compared to a "hypo". The "Hyper" condition leads to ketones in the blood, coma then death - without the necessary medical treatment!

Most diabetics depending on the time of flight would time their injections with their food intake as you correctly point out.

Please note though, Pax/Gannet Fan refers to glucogon and not "insulin" in the medical pack. Glucogon is used to treat Hypo when patient is unable to take sugary solids /drinks..

[Blues&twos]

Hyper vs hypo glycaemia.

If you are in any doubt or confused about which of the two your casualty is suffering from, give sugar.

It will immediately do a lot of good for the hypoglycaemic and may prevent unconsciousness etc, and won't do the hyperglycaemic any harm worth worrying about.

Hypoglycaemia has a rapid onset and must be treated immediately, hyperglycaemia has a much slower onset, although this needs to be treated as well, of course. Symptoms are different, if you want to know what they are the best bet would be to look it up in a First Aid manual!

If you come across someone who is slurring their speech, is v.aggressive and doesn't stink of booze, they may have low blood sugar.

(Or they're completely mad).

[Hombre]

Many thanks Blues&twos for expertly rounding off what I may say was an excellent thread! :ok:

[airbourne]

And people wonder why I dont tell them Im a diabetic!!!! Lots of scare mongering going on here. Firstly as a type 1 diabetic for over 2 years Ive learnt to control my lows. I carry my blood sugar tester with me everywhere. But if you do go hypo, Im sorry to say its your own fault! You just dont take a sudden drop! You feel yourself getting weak, and as soon as that happens test the blood sugar and if its low get some sugar into you! Simple, end of story! Ive gone as low as 2.2 and still able to function! If you pass out you have no concept of keeping your blood sugar under control!

As for the hypo kit, I got one when I first became diabetic. I NEVER used it! I carry a novorapid pen with me and go straight through security. In fairness, the needle hardly goes through the skin let alone anywhere else.

The way people go on you would think it was a deadly disease!

[flybywire]

Airbourne, the way you take care of yourself is something I wish to see in everybody, diabetic or not. It's good that you personally know how to recognise the feeling when it's approaching and how you can balance your sugar intake and your insulin when travelling on a plane for hours, but not everybody can do that.

Nobody was talking about it as if it were a terrible disease. However if it is not treated it can be deadly. We all know that the pancreas is one of those organs so [edited] useful and so [edited] needed for our system to function and so [edited] terribly difficult to replace/repair. If diabetes is not treated then it can be deadly.

Please do not take this thread the wrong way. We were simply discussing how we treat hypo and hyper cases in our airlines and so far it was a good and respectful thread, we didn't mean to offend you in any way.

And for the record, the last episode of hypoglycaemia I had on board was an 8 year-old boy travelling from the states to scotland, he was definitely shocked because of the night flight, eating routine all over the place etc. THANK GOD we are trained in recognising symptoms and treating them with what we have available, the last thing we would have wanted was for the poor boy to have convulsions half an hour before landing into glasgow.

You see, you might not need us but other people do. These things became so common during the years that all cabin crew around the world needed to be First Aid trained. The times of the glamourous jet-set life when beautiful hostesses were there only for your pleasure :E are long since gone.

Cheers

FBW

[Pax Agent]

FBW you are absaloutely right....at my airline (think we might be at the same one) we were told in AVMED never to take medicine off pax to refridgerate for them as 1) you are accepting responsability if some1 steals or accidently takes the medicine from the galley wine coolers and 2) insulin DOESN'T neeed to be kept cold when flying as it will be fine for 24hrs at room temp so when travelling they don't need to worry.

[flybywire]

Pax Agent.....definitely the same airline :E

[PaperTiger]

A hypoglycaemic episode is often accompanied by profuse perspiration, although there are obviously other factors to cause sweating on a flight. I would expect diagnosed diabetics to have a glucose meter with them, and CC should certainly be able to administer that test.

As mentioned earlier, even if it is definitely established as being hyperglycaemia, insulin should not be given without medical supervision. Even then it's risky. The dosage has to be right and it varies from patient to patient. Give too little and it will have no effect, too much and the subject can go hyper- to hypo- very quickly indeed.

Modern insulin keeps a lot longer than 24 hours without refrigeration. Humalin is good for 7 days, humalog and glargine 28 days.

[Hombre]

Airbourne, apologies in case your post refers to the few I have submitted!

I only started this thread because of flybywire's posts elsewhere and was concerned with some of her comments albeit I fully accept I misread her "Doctor on Board" comments/post vis a vis Hypo' Vs Hyper'. I have similarly apologised to fbw for this also, as any good Scotsman would!

Having lived with type 1 for 26 years I thought it worthwhile to iron out a few facts of the condition. To be fair Blues&twos put it better which I have subsequently acknowledged.

I have to say though on re-reading fbw's latest posts, in response to your own, I am slightly concerned with her tone which I consider to be a tad condescending (e.g use of "sooooo").

Diabetes is a wholly manageable condition but even the more experienced diabetics can be caught out despite taking regular BMs. Stress at work, unexpected exhilaration, fatigue etc... can all play their part in upsetting our sugar levels (whether diabetic or not). Airline travel can similarly have an impact and hence my reason for starting this thread.

As we've seen, a little knowledge can be a bad thing sometimes.:ok:

[flybywire]

Hombre, my "sooooo"'s were just an expression, I was not angry/upset/annoyed/anything else, I was just trying to keep it "light" if you know what I mean, as the thread was going well and didn't want for it to turn into something unpleasant. As I have said the last person I had who was having "hypo" problems was a child, so I feel that it is important that crew know how to deal with these possible problems.

However, I will go and edit my "sooooooo"s to make you happy and take all your concerns away.

Cheers!!

FBW

[Hombre]

:ugh:

As the child was 8 you took direct instructions from his parent/guardian then, yeh, to treat the apparent "hypo", rather than rely on your own knowledge of diabetes?

Please tell me so.

[GANNET FAN]

quote
The way people go on you would think it was a deadly disease!
Unquote

It is.

Well goodie for you that you can keep it under control all the time. But still only 2 years is not long and I'm sure you'll get it wrong sometime. You may or may not like my comments, I really don't care, but as one who has looked after 2 diabetics in the family (one for over 20 years) believe me I am more than qualified to share and exchange comments here.

This was an interesting and informative thread before you joined it.

[flybywire]

Please tell me so

I cannot tell you so Hombre, because the child was travelling alone (an Unaccompanied Minor, or Skyflyer as they're called over here) from the states to glasgow, all we knew was that he had diabetes (from the paperwork given to us by the ground staff) and we had him for the last part of his journey, from london to glasgow.

[Hombre]

That boy must have very "special" parents to let him travel in that manner.

[flybywire]

Possibly. However it is not up to me to question passenger's intentions and decisions. We have so many "special" children travelling alone in our airline for the most varied reasons, which is something we are proud of as it means that their parents trust our airline and, as a consequence, they trust us to take care of them.

[Hombre]

Fair enough.

Just for the record, can you tell me what made you think it was a "Hypo" and what exactly did you do to treat the poor wee lad.

To be honest I only ask as your previous use of "insulin" (contained within Post #7, paragraph one) when refering directly to Pax's previous posts Re GLUCOGON and/or Sugar gel (in the medical pack) still chills me a tad.

This was just a bad typo FBW, yeh??

[flybywire]

Hombre, it was just a typo, in fact nowadays I make loads of spelling mistakes and I even say red when I mean blue. I referred to Pax's post twice, once correctly and once about what I probably just imagined.In fact I will go back and remove the words "As Pax said" re. insulin and if you read my post again without that, it will make sense again! English isn't my first language, I am very close to giving birth (you might think it's not relevant, or you might not have direct experiencewith this situation but I want to explain it for clarity: I am so clumsy and extremely tired these days that I think only someone who's in the same situation can understand!I do not sleep at night and this does influence my way of responding to daily tasks!I probably shouldn't bother engaging in discussions on here however Ppruning is one of those few things that make me relax during the day!)

Right....It was about a year ago now, however I will try to remember as many details as possible for you. The boy came on board feeling very tired (after a night flight I would be too) we knew he had diabetes as it was on the paperwork and as soon as he sat down I offered him something to drink. He asked for a can of coke, which I gave him, however he didn't drink it and stowed it away in the seatpocket(I remember this as I thought that not many kids do that!) I chatted to him a bit like I usually do with skyfliers, then it was time to get ready to take off. During our in flight service (the flight was just about an hour) my colleague asked the boy if he wanted a sandwich/something to drink. He didn't reply. After several attempts she attracted my attention and immediately we understood that something was wrong. The boy was like completely "spaced out" and looked very pale. I had seen this before and we both agreed that we had to do something quick. The last time I saw somebody in that state (not on the plane) it was a matter of minutes before they had an episode of convulsions and we wanted to avoid that. A bit of sugar wouldn't have harmed him so my colleague tried to "feed" him some sugar while I got the senior at the front to open the box to get the gel. Captain was informed and an ambulance called to meet the aircraft on our arrival. That time the sugar/gel worked very well, and the boy started feeling a bit better. He was still weak but at least started answering us again. We then landed soon after and the boy was checked by the paramedics before disembarking.

It is not easy to understand 100% what is going on with people all the time, but the hypoglycaemic diabetic unfortunately is one of the most common situations. That's why I am happy when a diabetic informs me of their condition upon boarding, I appreciate that it may not be easy to travel long distances with this inconvenience, and I try my best to assist them the best way that I can. I do not mind at all serving food and drinks when they need me to.....if you know what I mean! The plane is my home after all!!

I hope I've clarified this episode, I bet that we as crew have not acted the way that you would have wished and I am sure that your next post will have some sort of criticism, but that's ok, we acted quickly and managed to solve the situation that day and in my eyes that's what counts. Nobody expects us to be doctors, or to have the knowledge of a doctor, however when we help and something then goes well it's only fair to give us some merit!! (My airline is quite good for these things, they recognise when you've done a good job and the paperwork goes in your file for future references).

That's it....don't remember anything else and even if I did I would probably make 1000 spelling mistakes so I'd better finish it here!

Happy Valentine's Hombre :)
FBW

[GANNET FAN]

FBW, you got it absolutely spot on and good for you keeping an eye on him. The great thing about coming out of a (non serious, convulsive type) hypo is that the subject usually is as right as rain pretty quickly.

And good luck with the new one...when it arrives
JC

[Blues&twos]

Good job FBW! Regardless of the circumstances surrounding why this lad was travelling and whether he was alone/unsupervised, you did the right thing, promptly, effectively and safely. That's what matters!
:ok:

[flyblue]

I agree with GANNETT FAN, diabetes is indeed a deadly desease. We had a passenger who died on board some years ago (in a company FBW knows quite well ;) ). He was accompanied by his wife who didn't alert us until it was too late. I have always wondered if his wife let him die on purpose (after all it is not very complicated for an accompanied adult to deal with hypoglicemia), but since they both weren't quite young, it is likely that they simply misjudged the situation :(

[flybywire]

Flyblue.....:eek: I had heard something similar during one of those long (very long.....good old times!) trips....but you know when you hear it from someone who heard it from somebody else etc you start to think that it's only the result of Galley FM being broadcasted across the fleet :E
Were you on board when that happened?!?:uhoh:

Blues&Twos thank you but I only did my job, we do have a number of children who travel alone for the most varied reasons and in the strangest situations possible. I once had to sit the whole flight with a 6 year old girl on my lap as she was crying her eyes out and was inconsolable! Her dad lived abroad and she was going to spend some holidays with him but missed her mum ever so much!! The situation of children of divorced/separated couples is so common we get used to tears and tantrums, and believe me I personally feel really sorry for the poor kids, but if I can do anything to make their journey a tad more enjoyable and I can steal a smile (or a drawing...my fridge is full of young talents' drawings!!) then I feel really satisfied!:ok:

Gannet Fan.....thank you, I have written you a private message, I think you're the best person to give me some advice, if you don't mind! :)

FBW

[GANNET FAN]

FBW, I have replied
JC

[Hombre]

FBW, best wishes for your impending delivery. Your life will never be the same again!! Keep up the pelvic floor exercises.

For the avoidance of doubt, I would be happy to fly with you anytime whether you are on duty or not!:ok:

[flybywire]

Thank you Hombre! you'd be welcome on board anytime!

And don't worry......I practice those exercises every time I am stuck in traffic :E

[gingernut]

It sounds like you've got the hypo/hyper thing covered, but here's my twopenne'th.

Firstly, crossing time zones, dietary restrictions and the stress(!) of travelling is a pretty good formula to mess up diabetic control.

Hypoglycaemia is usually sudden onset, and, as posters have previously posted, instantly treatable with sugar ingestion. Note though, never try and force liquid/food into an unconscious patient- you could kill him/her. (Hypostop is safer).

Recovery from hypo's is usually instant, but be wary that the patient is likely to seep back into a hypoglycaemic state if some complex carbs (eg toast/pasta) arn't taken soon. The stuff used for recovery is usually metabolised rather quickly.

Hyperglycaemia, usually (but in medicine we never say never or always), has a slower onset, usually day's rather than hours. Smelling "pear drops" on the breath could indicate trouble.


Safe flying:)

[Blues&twos]

Unless you have a mate like I have, who suffers from hyperglycaemia and is also very partial to peardrops. The git. He's caught me a number of times with that little "joke".