Near the end of June, I volunteered to help out at a 10k race.
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The race day temperature was about 93 degrees with a heat index of 103 so we were recommending that the runners drink extra water, and slow down if they felt weak or dizzy. Because this was a fund-raiser as well as a race, a lot of participants were not in the best physical condition. About 4 miles into the race we got a call that a runner was down, and vomiting and dizzy. We immediately answered the call and found the patient to be quite lethargic….
He was not an athlete and we assumed that he was someone who did not often run in races. Thinking that the runner was dehydrated, we tried to treat the patient with a sports drink that had glucose and electrolytes. The patient did not seem to be responding and after 35 minutes we called for an EMT vehicle.
When the EMT's arrived the first thing they did was take the patient's glucose which was 499 mg/dl.
The EMT talked to the patient and discovered that he had type 2 diabetes, was on insulin and had not taken any in the morning because he was afraid he would go to low during the race. The EMT immediately gave him 10 units of rapid acting insulin. We kept the patient in the shade at the rest station and 2 hours later his glucose had returned to 155 mg/dl.
Lesson Learned:
Many patients think that insulin is for lowering high glucose levels without having any basic knowledge that it is needed to move the glucose into the cells. If there is no insulin present then all the glucose that the patient consumes, even during exercise has no way of being moved into the cells for use. This means that in addition to the glucose levels rising, the body will have to break down free fatty acids to burn during the race, increasing the risk of ketoacidosis.
Alanna Michaels RN
Chillicothe, VA
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