High Blood/Sugar

[slowjet]

I know the Type 2 debate has been done to death but the thing I am just not getting is why, if you have type2 and you lapse into a diabetic coma you are given anything sweet to pull you around ?
II understand all about high levels of sugar. I understand all about low insulin. So, if left untreated, wouldn't the type 2 sufferers have high sugar levels ? Why pop them a malteser if they have passed out ?

It's ok. I'm in the clear but a mate has just been given the red card and some of the advice given is very contradictory. Oh & don't get me started on statins !

[Radgirl]

Type 2 rarely if ever results in a coma. Indeed I would question the diagnosis

Type 1 hypo - low blood sugar - give sugar

Type 1 hyperglycaemic coma ie HIGH blood sugar - give insulin. However this needs hospital management and is far more complex.

In other words you can lose consciousness or be unwell because your blood sugar is too low or too high

[Landflap]

Radgirl ,Thanks v much. Type one hypo or Type one Hyperglycaemic how would you know ? On discovering a passed out individual , assuming a multi crew environment,why the person had passed out, unless the person had some sort of ID " I am diabetic, give me sugar " sort of thing would be quite difficult . My mate has had his licence suspended following the detection of Type 2 which he suggests isn't type 2 but just high sugar levels because that is all he intakes, rather than proper food, on long trips. Doc grounding him said that if all is cleared after monitoring & review he would get his licence back but with a multicrew only restriction.. The risk being that he had a " high risk of passing out" and in a non- multicrew environment could be disastrous. Not only is he questioning the diagnosis but the statins etc are having very serious side effects . Of course he has informed the Doc.

He took the routine medic renewal after arrival on completion of a ten-day trip away living on sugary drinks and mars-bars.He explained all to the AME but has been given big yellow flags by all. He is on a two week course of these medications after which first stage review will be made.

[Radgirl]

Low blood sugar comes on quickly but high blood sugar is a slow deterioration

Your mate does indeed have diabetes. That is what a high blood sugar is called. I would see this as a wake up call and hopefully he can get some diatetic advice because that sort of diet will cause far more harm than just diabetes. A good diet, loss of weight and exercise can reverse type 2 in some cases.

[Landflap]

Thanks again Radgirl. Very clear and I think I get it, now. We need you in our Training Department to help straighten bods like me out on a number of technical misunderstandings. Never got Electrics and don't get me started on Pitch enhancement {!). I do know of another case though, very similar to the one I just referred to. He too had very weird diet, full of sugar and weighed in at 100kg measuring 5ft 8 inches. But regarding, use of terms in professional mode a lot of us don't get ,he too was told he had diabetes after submitting to blood test during medical renewal upon arrival off a long trip away. He fought back claiming he had high blood sugar, not diabetes .His AME actually said ;" You don't have diabetes, you are just hyperglycaemic (!). Blimey, Lawyers are even worse !

This guy was in the Middle East and grounded by the Company Doc. In the intervening period, he was cleared by the UK CAA and given a Class one.He ditched the statins. He took the UK CAA Class one to his AME who gave him the local Class one and Matey took that to Crew Control who put him back on the roster. Local Company Dr was away on leave. When she got back, she went ape-****e and re-grounded him.(Loss of face syndrome , rife in the ME). He eventually got back local licence medical with MOL but the statins nearly killed him.

The mess put him in direct conflict with Management and he was, later, booted out in a massive stitch up.

In early retirement, he. dropped to 75kg from 100kg. He loves a mediterranean diet & drinks only local wine. I agree with your last sentence . I think he has reversed his type 2..........if he ever had it !

[First.officer]

Being someone who operates in (currently) EASA land, and who was diagnosed as being a Type 2 diabetic (Diabetes Mellitus) - now in remission - the current 'gold standard' test that is used to ascertain status in the UK, is the HbA1c test (glycated haemoglobin). The threshold limits as stand currently (unless corrected) are that less than 42 mmol/mol are non-diabetic levels, between 42 and 47 mmol/mol are Pre-Diabetic levels, and 48+ are Diabetic levels. The HbA1c test is an average of you blood glycated haemoglobin over approximately the last 2-3 month period, as this is generally the accepted timescale over which blood haemoglobin is completely replaced within the human body. The effects of statins and blood glucose effects are well known, and yes can prove detrimental in increasing the HbA1c figure over time, but equally this may prove more beneficial in some individuals as opposed to the increase risk of elevated blood glucose and associated effects (neuropathy, retinopathy, CVD etc.). A high sugar diet in the previous 10-days generally speaking will not make a huge difference to nay HbA1c test conducted during consumption, or immediately after - there is a school of thought that suggests the last 4-weeks of moderated glucose (carbohydrate) intake is moderately beneficial to reduce HbA1c figures.

I would suggest that your friend invest perhaps in a home HbA1c testing kit, or maybe day-to-day self monitoring using readily available testing kits as sold in most high street chemists? yes, there is a cost of course in doing these - but if nothing else, will assuage the fears he/she may have and help to monitor what is really happening. If you buy the right kit, there are some great apps and bluetooth transmitting functions that make report production and trend monitoring very easy. And in the early days, dietary methods alone seem to have good results in regaining normalised control. Its worth (ney, essential) to consult a dietician or GP before embarking on a diet method as there are effects that can alter lipid profiles and alike. Be wary of the suggestion of going straight to the medication route (metformin etc.), as there can be some 'explosive' results (think bowels!) in individuals, and adds more restrictions in medical renewals.

The UK CAA guidelines to renewals and re-gaining class 1 status, are all available on their website and well worth referring to - along with your AME of course!, as they ultimately have to sign you fit again once controlled levels are achieved and no other issues apparent.

Hope this is all of use.....

[Landflap]

FO ; Very helpful and very clear. Thanks very much .

[gingernut]

Low blood sugar comes on quickly but high blood sugar is a slow deterioration

An accurate account. As ever, Radgirl is on the ball.

One slight caveat, diabetic control has become a lot stricter than back in the day, (for good reason.).

As such, some of the antidiabetic meds we use are a little more powerful, so, can, technically, could induce hypoglycaemia. In reality, I see lots and lots of type 2 patients, and have never come across this. (yet!)

Type 1 is a slightly different matter. The agents used are, I think it's fair to say, a little more "volatile." This is because the mechanism of disease is different, total destruction of the insulin producing cells vs wearing out. (The picture is actually a little more complex.)

As regards "warning signs" i that's a bit of a difficult one. Treat a "collapse" as a "collapse" in the first instance.

Obviously, history of past events could give a clue as to what's going on. Realistically, I'd be obtaining some info from the family, and maybe try and obtain an in the field blood glucose reading before shoving anything in their mouth. Remember, your patient is in a state of collapse, so you have to be very careful before putting anything solid near their airway.

The other thing to think about, is, if you do "bring someone round" with a Malteser, then the recovery period will be quite short lived, as maltesers are very simple sugars......more complex sugars, that break down slowly, are then needed. (Beans on toast are my fave.)

As Radgirl says, hyperglycaemia, is a whole different kettle of fish.

Long term, it's a killer, short term is rarely an issue, unless the patient is ketoacidotic, which is a whole different ball game :-)

Safe flying.