Heatstroke/Sunstroke - Part 5

Part 5 - Treatment

 

Urgent Care

 

If someone shows the signs of sunstroke, seek medical treatment or call 911 immediately. Before medical treatment arrives, move the individual to a cool area. Look for any medical alert notices – bracelet or necklace or even ankle bracelet. Provide cool drinks, preferably a cool (not cold) drink containing both a little sugar and salt. Remove any constricting clothing. If the person has diabetes, do not give liquids containing sugar unless meter readings can be taken to verify blood glucose readings.

 

Treatment strategies depend on the severity of the symptoms. Treatment for sunstroke begins immediately upon diagnosis by a medical doctor. In mild cases, the body can be effectively cooled by taking the patient to a shaded or air-conditioned area, removing most clothing and applying cool water or ice packs to the skin. Drinking iced fluids also helps return the body temperature to a safe level. In severe cases, treatment involves rapid cooling, either by immersing the body in an ice water bath or by evaporative cooling. In the latter procedure, large circulating fans blow cool air across wet skin.

 

Self Care

 

Take steps to prevent heatstroke and sunstroke. Drink plenty of water, stay out of the sun, and avoid strenuous activity during hot weather. In addition, avoid drinking caffeinated beverages to keep yourself from becoming dehydrated.

 

If you start to experience the symptoms of heatstroke, move to a cool, shady area and drink something cool, preferably a beverage containing both sugar and salt. Warning – be careful giving sugar to a person with diabetes.

 

Prognosis

 

Recovery from sunstroke depends on the speed and effectiveness of diagnosis and treatment. When treatment for sunstroke is administered promptly, the patient can expect a full recovery in one or two days. In severe cases, when body temperature climbs to 106°F (41.1°C), sunstroke can cause shock. After prolonged exposure to such high body temperatures, brain damage can occur. Death occurs in about 20% of heatstroke cases according to one study. The likelihood of dying from heatstroke increases with a longer duration of heat exposure.

 

Follow-up

 

After a full recovery from heatstroke, little follow-up care is needed. Recovered patients may want to rest and stay in cool areas for several days. Patients should also adopt aggressive prevention strategies to keep sunstroke from recurring.

 

How do you treat a heat stroke victim?

 

Victims of heat stroke must receive immediate treatment to avoid permanent organ damage. First and foremost, cool the victim.

 

• Get the victim to a shady area, remove clothing, apply cool or tepid water to the skin (for example you may spray the victim with cool water from a garden hose), fan the victim to promote sweating and evaporation, and place ice packs under armpits and groins.

• Monitor body temperature with a thermometer and continue cooling efforts until the body temperature drops to 101-102°F (38.3-38.8°C).

• Always notify emergency services (911) immediately. If their arrival is delayed, they can give you further instructions for treatment of the victim.

 

 

 

Heatstroke/Sunstroke - Part 4

Part 4 - Diagnosis


Sunstroke is typically diagnosed on the basis of symptoms alone. To get the best measure of your body's core temperature, your doctor may use a rectal thermometer. Your doctor may also take your blood pressure and ask for a blood or urine sample.

Your doctor may perform tests to rule out conditions with symptoms similar to those of sunstroke. Irregular heartbeats, a heart attack, a fever-causing infection, fluid loss related to medications, or cocaine intoxication can mimic sunstroke by causing elevated blood pressure and body temperature.

Risk Factors for Sunstroke:

Very old or very young age

Low level of physical activity

Obesity

Smoking, drug, and alcohol use

Heart disease

High blood pressure

Diseases of the skin, kidney, or liver

Decreased ability to sweat, such as in scleroderma and cystic fibrosis

Medications that can aggravate sunstroke, including water pills (diuretics), allergy pills (antihistamines), tranquilizers, anticholinergics, and amphetamines

Heavy, restrictive clothing

Poor ventilation or lack of air conditioning in home

High humidity

This is why it is so important to get someone suspected of having heatstroke or sunstroke to a doctor or emergency room as quickly as possible. Using the 911 call is the fastest and best way and the reason this is repeated through out this discussion. Other items are repeated as well to emphasize their importance.

Heatstroke/Sunstroke - Part 3

Part 3 - Symptoms


Symptoms of sunstroke/heatstroke can occur suddenly. Once your body loses its ability to regulate heat, body temperature can rise quickly. Symptoms of sunstroke include sudden headache, dizziness, weakness, or fainting. Because your body's thermostat is malfunctioning, you will only sweat a little bit or not at all. The skin is hot and dry. Body temperature can rise to 102°F (38.9°C) or higher. In severe cases, repeated vomiting and coma can occur.

Risk Factors

Young children and the elderly are at an increased risk for heatstroke and sunstroke. Young children who rely on others to modify their environments, for example, to remove extra blankets or heavy clothing, may be sensitive to rising temperatures. Elderly adults are less sensitive to changes in temperature, so their thermostats work less efficiently. People with excess body fat are also more likely to retain heat.

Conditions or medications that cause dehydration can increase your risk for sunstroke Skin disorders such as scleroderma can interfere with your ability to sweat. Dehydrating medications; for example, the diuretics furosemide (Lasix) or hydrochlorothiaszide (Esidrix) make less water available in the body for sweat, thereby crippling your body's cooling system.

What are heat stroke symptoms?

Symptoms of heat stroke can sometimes mimic those of heart attack or other conditions. Sometimes a person experiences symptoms of heat exhaustion before progressing to heat strokes.

Symptoms of heat exhaustion include: nausea, vomiting, fatigue, weakness, headache, muscle cramps and aches, and dizziness.

However, some individuals can develop symptoms of heat stroke suddenly and rapidly without warning.

Different people may have different symptoms and signs of heat stroke. However, common symptoms and signs of heat/sun stroke include: high body temperature, the absence of sweating, with hot red or flushed dry skin, rapid pulse, difficulty breathing, strange behavior, hallucinations, confusion, agitation, disorientation, seizure, and coma. In the more severe cases, heatstroke can even cause organ dysfunction, brain damage, and death.

Heatstroke/Sunstroke - Part 2

Part 2 - Causes


Sunstroke results from a failure in your body's cooling system. When its cooling system fails, your body is overwhelmed by excess heat; this is when sunstroke occurs. Anything that disrupts your body's thermostat can increase the likelihood of sunstroke. These may include such factors as underlying medical conditions, medications, physical characteristics, or age.

Dehydration contributes to sunstroke. Dehydration happens when your body excretes more water than it takes in. For example, increased water loss through excessive urination is a common side effect of caffeine, alcohol, and many prescription and over-the-counter medications. When the water supply in your body is low, cells begin to pull water from the bloodstream, forcing organs to work harder. Dehydration can also affect the skin's ability to cool the body efficiently. The heart must pump an adequate supply of blood to the skin in order for the skin to cool the body. When you are dehydrated, the blood's volume is reduced, so the cooling process becomes less effective. The taxing effect on the body escalates into the symptoms of heat-related illness.

Prolonged exposure to the sun contributes to sunstroke. When body fluids are not adequately replenished, sun exposure can cause rapid dehydration. Even on mild or overcast days, the sun can have dangerous health effects. The heat index is a measure calculated by the National Weather Service. It indicates how hot it "feels" outside in the shade when both the air temperature and the relative humidity are considered. In the direct sun, the heat index rises even higher. The following heat indices are associated with these heat-related conditions:

80°F-90°F: Fatigue possible after prolonged physical activity or sun exposure.

90°F-105°F: Heat exhaustion, heat cramps, and sunstroke possible after prolonged physical activity or sun exposure.

105°F-130°F: Heat exhaustion, heat cramps, and sunstroke likely after prolonged physical activity or sun exposure.

130°F and higher: Sunstroke likely with sustained exposure to the sun.

If heat exhaustion is not promptly taken care of, it can quickly progress to heat stroke. Heat stroke is a more urgent matter and is a medical emergency. Symptoms can include warm, flushed skin, little or no sweating, and an extremely high body temperature. Confusion, loss of consciousness, or seizures may also occur. A call to 911 is the best way to get help fast.

Heatstroke/Sunstroke - Part 1

This is a large topic, so for simplicity I am dividing it into 6 parts: Basics, Causes, Symptoms, Diagnosis, Treatment, and Prevention.



Part 1, Basics

I live in the north central part of the US, and generally have about four or five months that I need to be concerned about heatstroke. Others have more or less time to be concerned depending on their location.

I had heatstroke as a teenager, but have been able to adapt and have not had a reoccurrence. Yes, I am probably more conscious of what is happening now with that experience.


Summer is the time of year to enjoy being outdoors. When summer arrives here, so do generally high temperatures and high humidity. People with chronic conditions have to be even more careful in the heat than usual, especially with diabetes.


Hot summer weather can cause dehydration very quickly. It is important for everyone to increase their intake of liquids, not just people with diabetes. However, those of us with diabetes, have to know that dehydration can also occur when blood glucose levels are high, regardless of temperature, so when you are outside, it becomes doubly important to increase your intake of fluids.


1. Drink plenty of fluids throughout the day, especially water and even if you are not thirsty. Do not drink sugar-laden juices and sports drinks though -- they can just compound the problem. Beverages containing caffeine in moderate amounts do not seem to affect blood glucose levels. However, consuming large amounts of caffeine over a shorter amount of time seems to raise blood glucose in some individuals.


NOTE:  If it is important to replace electrolytes, then some sports drinks may be necessary and extra testing may be necessary.


2. Exercise or do activities that are more strenuous in the early morning hours or evening hours of the day when temperatures are cooler and the sun is not at its zenith.


3. It is also recommended to check your blood glucose levels often when it is hot outside. Both hyper and hypoglycemia can be a problem during hot weather.


Heat stroke is a form of hyperthermia. This means that you have an abnormally elevated body temperature with accompanying physical and neurological symptoms. Unlike heat cramps and heat exhaustion, two forms of hyperthermia that are less severe, heat stroke is a true medical emergency that can be fatal if not properly and promptly treated. I would urge everyone to be aware of this fact alone.  A 911 call is important for fast action.


In very dry air, sweat evaporates easily, quickly cooling your body; but in very humid air, sweat does not evaporate. It may collect on the skin or run off your body without affecting your body's climbing temperature.


Extremely warm and humid temperatures can quickly overwhelm your body's cooling system - especially when there is not a breeze. When sweating can no longer keep you cool, body temperature quickly rises, causing the symptoms of heat-related illnesses.


Sunstroke is a type of heatstroke. Heatstroke is a condition that occurs after exposure to excessive heat. In sunstroke, also called heat illness, heat injury, hyperthermia, heat prostration, and heat collapse, the source of heat is the sun. Other types of heatstroke occur after exposure to heat from different sources


Heatstroke, including sunstroke, is considered the most severe of the heat-related illnesses. Heat can have punishing effects on your body. After excessive exercise or physical labor, your body can overheat, and you may suffer heat exhaustion.


Heat cramps occur after excessive loss of water and salt; usually resulting from excessive sweating, or after strenuous exercise or labor. During heat exhaustion and heat cramps, the heat, controlling system is still intact, but can be overwhelmed.


It is necessary to know the signs and symptoms of heat exhaustion, too, since the risk is higher in people with diabetes. If heat exhaustion is not taken care of, it can quickly progress to heat stroke. Heat stroke is a more urgent matter and is a medical emergency.


The body normally generates heat because of metabolism, and is usually able to dissipate the heat by either radiation of heat through the skin or by evaporation of sweat. However, in extreme heat, high humidity, or vigorous exertion under the sun, the body may not be able to dissipate the heat and the body temperature rises, sometimes up to 106°F (41.1°C) or higher.


Again - - A call to 911 is the best way to get help fast.


Resting in an air-conditioned room or another cool place and drinking more water should make you feel better. If you suspect heat exhaustion, call your doctor. He or she may want to follow up with an office visit or other interventions. If the doctor is not available, I suggest a visit to an emergency room.


Those most susceptible to heat/sun strokes include: infants, the elderly (often with associated heart diseases, lung diseases, kidney diseases, or who are taking medications that make them vulnerable to heat strokes), athletes, and outdoor workers physically exerting themselves under the sun.


The summer heat can also be a concern when trying to carry supplies such as insulin, meters and strips with you. Insulated bags with small refreezable gel packs are good for keeping things cool. Keep equipment out of direct sunlight as much as possible.


With some advanced planning and special considerations, summer can still be a safe and enjoyable time of year.

Defined by Diabetes

Many people with diabetes speak and write about not letting diabetes define them.  They go to great lengths to state how diabetes cannot and will not define them and their lives.  I sincerely hope that their wish is granted.

I have to admit that I felt this way for a while and I thought I had possibly succeeded.  However, after a long look in the mirror, I for one, know that my life now is defined and shaped by diabetes.  I write about diabetes and about diabetes service dogs.  I spend much of my day reading and researching diabetes, finding topics that I feel comfortable writing about and how diabetes affects me.

Of course, being retired helps me find the time to devote to this and enjoy doing these things.  Whether I am able to help people or not, I look forward to sharing information with those ready to learn. 

Diabetes has meant adding more doctors for me to see.  I occasionally saw a podiatrist for an ingrown toenail or when I had planter warts, but now I see one on a quarterly basis to maintain healthy feet and to catch potential foot problems early.  I never had need of an endocrinologist before diabetes, but now I see one on a quarterly basis.

I started seeing a neurologist for sleep apnea and what was neuropathy approximated three years before I was diagnosed with diabetes (should I have known what was coming then?).  Now I see him at least twice a year and sometimes more often.

When I was diagnosed with diabetes, I was in the hospital for angina.  Therefore, I see a heart doctor at least twice a year.  I have always seen a urologist since I was a teenager and was kicked in the groin by a cow; however, now I see him additionally on a regular basis for checking my kidney health. 

This year, I am planning on adding an oncologist for possible yearly visits to do a cancer check, partly because of age and family history, but also because I use lantus insulin.  I still see my primary care physician on a quarterly basis.  I have other doctors and specialists I see on an irregular basis, but in general my doctors are definitely a sign that I am a person with diabetes.

While I could say I don't want my life defined by diabetes, I find it is, and in some ways this definition is a good thing.  It has caused me to be more conscious of my health and to be much more proactive in my health care.  While some of my doctors may not be overly happy with my being proactive, most are happy and actually talk with me rather than at me.  My diabetes has also forced me to be more social in the way I look at things, and more important, more willing to accept changes.  While I am still feisty and ill-tempered at times letting my negative side get me into hot water, I am finding myself mellowing and becoming more even in my approach to life.

Diabetes makes me who I am now, and I will not deny this.  I must test my blood glucose on a regular basis, both pre and post meals.  I will do extensive testing from time to time when I add new foods or want to add new to me foods, and when things seem to be changing for me.  I count carbs, do what I am able for exercise (and this is getting better), and take care of myself.  I do let my wife help when needed.

When people actually stop and think about it, diabetes does affect the decisions those of us with diabetes make on a daily basis.  It affects the foods we choose, which fortunately are more healthy for us than the ones we were eating before diagnosis.  It affects the restaurants we patronize, the snacks we eat and to a large part when we eat.

Therefore, by being more realistic, I am gaining better control and not wasting time denying my diabetes.

Official and Unofficial Types of Diabetes

The American Diabetes Association only recognizes a few types of diabetes.  I referred to them and missed a few in my blog of Aug 18, 2009.  If I had been on the ball, I would not have missed the article by Dr. Bill Quick of Aug 17, 2009 where he correctly listed them and the subgroups.  He obtained his from a posting on the ADA site.  The official termination for diabetes includes:

1. Type 1 and this includes LADA (Latent Autoimmune Diabetes in Adults)
2. Type 2
3. Gestational
4. Other specific types and includes several subgroups (which I will let you read for yourself) and includes MODY (Maturity-onset Diabetes of the Young)

If I have missed something recently published, please let me know.

The unofficial types, or what people want you to believe are recognized, are presently listed as two types only; however, several groups and organizations are competing for each type.  I have not included what I stated in my previous blog.

Type 3. 
Among the groups and organizations that want this unofficial type are some that want to include several of the ADA approved definitions in this to muddy the waters and add to the confusion.

• A combination of type 1 an type 2 - autoimmune and insulin resistance in young people and adults.  This is a recent development caused by overweight individuals.  The following are wanting type 3 for this condition.   The group at Battle Diabetes.com,  lifescript .com, livestrong .com, and askginny are   supporters of this.
• Lack of insulin produced in the brain which seems to lead to Alzheimers and/or dementia.  This is supported by the burrillreport .com, inventorspot .com, and new-treatment for diabetes.
• There is some that want the different types of MODY classed as type 3.  Some even want the different types of MODY separately typed (3A, 3B, 3C, etc..  These include wikihealth .com and diabetesindex .com.
• Gestational diabetes is another ADA approved that people want type 3 assigned to.  Aparently a doctors website is wanting this as is another group.

It is interesting how these groups are also trying to get acceptance for their way of classifying diabetes.  It seems that stepping outside ADA is a popular thing to do by various groups.

Type 4. 
Several groups also want this assigned to their way of classifying diabetes.

• Gestational diabetes - again someone wants this classed as type 4 and one of these is wikihealth.
• Hypoglcemia - here an individual is the one on the bandwagon and has written a book doing just that.
• Some of the subgroups included in the ADA definition are included by the doctors website as type 4

The confusion by many individuals is understandable with all the different websites each claiming that their classification is what you should assume is correct.  It seems that many want to be credited with naming the types of diabetes. 

What surprises me is that a new unofficial term of prediabetes is not advocated for in my research efforts yet.  Yes, I am sure that there are those just waiting to do this and if I have not found it, I will shortly.   The ADA has written about it here, but not officially listed it as classification, which may be discouraging some from trying to coop it for their own.

Until the ADA takes a stand and tells individuals, groups, and organizations that they must label their difinitions as unofficial we will continue to have confusion.  On this I will support Dr. Bill Quick when he states "In my opinion, anyone using unofficial terminology, such as type 1.5 or type 3, should acknowledge that it is unofficial, and clearly define what they are talking about."  Here I would include type four and others that show up.

It is time that the ADA came forward and made a statement about those professing that these types are in existance and clear the air about all these unofficial classifications.  The ADA could also comment on the possible types under consideration and let people know that as of yet they are not official.  While I do not always agree with the policies and recommendations of the ADA, we do need an official organization to keep the confusion to a minimum.

Surprises on Diabetes Forums

Sometimes we all have to wonder what is happening.   Many of us know that we have to eat by what our meter tells us.  We know that the ADA guidelines are there for a reason; however, by using our meter we know that the guidelines are out of our reach, but maybe not for everyone.

Maybe this should more appropriately be titled Move over ADA, the Diabetes Forums will now set the standards.  This does not include the smaller forums and those outside the US.  They generally have different agendas.

While all forums do a lot of good for people with diabetes - all types - they all have their idiosyncrasies which take some time to adjust to.  Some of these are good because they allow for people with different needs and personalities.

For the four largest US Diabetes Forums, the challenge apparently is being in disagreement with the ADA or finding ways to create conflicts.  Whether this is intentional or just their aggressive posturing and marketing strategy remains to be understood as the forums are very closed about what they do behind the scenes.  However, let the members say too much against the ADA, and the moderators will discourage or stop this by what ever means they feel appropriate.

The large diabetes forums are trying to usurp ADA in the designation of types of diabetes.  They do not make any statements that this is an unofficial designation and that the designation is for simplicity.  This is important because by their actions they are misleading their members.  Unless their members are diabetes and ADA savvy, they will assume the forum they belong to is correct.  This applies to type 1.5 (LADA) Latent Autoimmune Diabetes in Adults.  The ADA designation is LADA and it is included in the discussion of Type 1.

Three of the four forums has the audacity to label a group of people that do not have diabetes as a Type 3 class.  I believe all four do this, but have not found it in the last one. There are many other examples put forth by the forums, but this is a topic for another blog.

This is explained (lamely) as including family members and friends of people with diabetes and caregivers.  Offended, VERY MUCH SO!  My wife, daughter, and son are also offended, and like myself do not like that my family members are disrespected and stereotyped because people are lazy.  It is my diabetes, not theirs.  My family respects that I am able to take charge and not force them to be part of my diabetes.  I know they would come to my aid if and when it may be needed.

Even some of the bloggers in the Diabetes Online Community (DOC) have classed people without diabetes as Type 3. (same as above).  While I can agree the family and friends may be an integral part in the support of family members with diabetes, they should be given the respect they deserve and not stereotyped.

While the ADA is slow to recognize some forms of possible diabetes, I have to wonder where the four diabetes forums have received the authority that they seem to be so willing to flaunt in the face of the ADA.

On March 9, 2010, a question was asked about the policies of one forum.  What followed was not the prettiest with members generally on one side and site personnel on the other.  It can be found at the first post (link broken) and the topic is locked at seven plus pages.  Before reading all of the information, it would be good good to get a different perspective on the topic of resistant starch.  While the forum did not say how long resistant starch has been in existence, they presented it as the latest help and miracle tool for people with diabetes.  My research is telling me that resistant starch existed before 2004.

Before I get too far into this, I will stop and let Tom Ross finish the topic by referring you to his blog (link is now broken) of March 11, 2010.  He has done an excellent job of covering the topic and discussion on resistant starch.