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OB centers in mountain areas provide mountain rescue teams. These teams are composed of instructors, backed-up by the students in the centre at that time if more manpower is needed, for example, for a search. Thus, the BDA/OB course students may be called on to help with rescues in Eskdale. Besides, since all participants go on mountain expeditions it is important that they know what to do if something goes wrong.

At first I started giving everyone basic first aid training. However, it rapidly became obvious that people with diabetes know a good deal more about first aid than non-diabetics of the same age. So later courses have had more advanced first aid training. Participants go on exercises to solve all types of difficult problems, such as what to do with the fallen climber or the hypothermic camper, and they cope very well.

To start with, first aid and rescue sessions take place on the campus. As groups become more experienced they are given search and rescue exercises in the mountains. They set off with one or two stretchers and locate the casualty, usually the long-suffering medical officer or nurse, made up with dramatic injuries. They are also often hampered in their efforts by a ‘hysterical friend’ who gets in the way and has to be rescued too. The rescue usually culminates in a stretcher being lowered over a cliff, which needs team work and coordination from the participants and steady nerves on the part of the casualty. These exercises may start off as a game but they rapidly become serious as students realize that they are taking responsibility for the casualty’s life, actor or not. Obviously, all the exercises are supervised by instructors.

If someone with diabetes has an accident in the mountains all the usual first aid principles apply: maintenance of airway, breathing and circulation, stopping bleeding, and ensuring that an unconscious person cannot inhale vomit or other material. Obviously, the casualty must be carefully assessed, treated for injuries and protected from further harm while mountain rescue procedures are put into effect and help is sought. The additional factor with a diabetic casualty is the blood glucose level. This should be measured at hourly intervals and written down in the record you are keeping for the rescue services. If the glucose is below 3.5 mmol/1 (63 mg/dl), oral glucose should be given. Glucose can be swallowed by a conscious casualty and rubbed inside the mouth of an unconscious one. Record the amount of food or drink given to the casualty and the time at which it was given. Hot, sweet tea may be especially helpful in cold weather. It may take many hours for help to arrive, but in situations where help can arrive fast and there is no risk of hypoglycemia do not give the injured person anything to eat or drink. Normally one should not feed anyone who has been injured as it could cause problems if they need an anesthetic. If the casualty’s glucose level is above 13 mmol/1 (234 mg/dl) give 2 units of rapid-acting insulin, intramuscularly, so that it is better absorbed. This can be repeated hourly if indicated.

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DIABETES

The testes and ovaries are also very sensitive to radiation. The ovaries may be irradiated either deliberately, or incidentally when * nearby organs are treated. Because they lie within the pelvic cavity it is difficult to shield them from nearby irradiation. The effect depends on the dose. Anything more than very small amounts of radiation is likely to stop menstruation permanently. You would become infertile—unable to have babies. Unless you took replacement hormones, you could experience any of the possible symptoms of a normal menopause, such as hot flushes, relative dryness of the vagina and possibly a loss of interest in sex. If your periods stop, I strongly suggest that you take small doses of female hormones until the usual age of menopause (about fifty) to replace those that would normally be produced by your ovaries. Ask your doctor to prescribe these if they are not offered to you.

The testes, because of their position, are much easier to shield off when nearby areas such as the groin are irradiated. They should receive only a small dose in such cases. If they received a large dose for any reason, they would become small and soft, your libido (interest in sex) would diminish and you would probably become permanently infertile. You might still be able to get an erection and ejaculate (come). However, regular injections of male hormones to replace those normally produced by your testes would probably be needed for normal sexual feelings and function. With or without the hormone injections, your ejaculate would contain very few or no sperm. There is no treatment that could make you fertile.

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Cancer