Low blood sugar, juice or D50? - page 3

Last night I had a patient with a BS of 39. I had just finished giving report on her when she asked us to check her BS. Since the oncoming nurse still had to get report on a few more patients, I got the aid to check the BS then... Read More

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    Quote from alem-tsahai
    x2 what the above poster said. Your intervention was absolutely fine, but I wouldn't have given report on that pt until AFTER I had re-checked the FS. The oncoming nurse had nothing but subjective data to go by so she is probably just trying to cover herself by giving the D50.
    Report was in process when the patient alerted staff of her hypoglycemia.

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  2. 0
    I would have done just as you did. Or sometimes instead of Glucerna I will give a regular Ensure. Working in LTC provides a better advantage of preparation because we pretty well know who is most likely to bottom out and who isn't; so we are able to prepare accordingly. If I'd been in your shoes I would have done exactly the same thing and continued to monitor the patient since she was technically still "your patient" and you'd been with her the whole time. The on coming nurse's task was to simply follow up on the patient after she'd received report and then if further action was needed she could follow up with other interventions.
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    Just as an FYI, the patient had been off the floor for awhile. She left frequently to get "fresh air". She had eaten a full dinner before she left (I saw her eating and saw her empty plate.) The oncoming nurse and I were standing outside her room for report when she walked in and told us she needed her sugar checked. We were done with report so the other nurse went to get report from someone else, I got the aid to do the accucheck (I would have done it myself but the aid was standing right there and not busy.) When the aid told me the BS, I immedietly took her the juice, etc. I stayed with pt about 10 minutes, until the other nurse was ready to take over.

    I don't know if the other nurse ended up giving the D50 or not. I will review the policy next shift.

    PS...to the person who said juice seems to work better thand D50 anyway. I find this with K+. If I give oral K+ it seems to work much better than runs. And runs are sooooo hard on veins, I try to give oral as much as possible if the patient can actually take them.
    BrnEyedGirl likes this.
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    our protocol sayd juice and a snack also if the client is able to tolerate it. then recheck, if still low D50 and call md
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    What would you do if your patient was diaphoretic, unconscious, and blood sugar of 30? Would you first inject dextrose?

    ConcreteRose24 likes this.
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    If they were unconscious? Of course the D50.
    ChristineN and CountyRat like this.
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    Unconsious: Medical Emergency and D50

    Conscious and able to talk: I'd do as the original poster did. I've had a patient with a BS of 34 at my previous facility, was conscious and her only symptom was feeling weak and seeing black spots. Got her OJ spiked with sugar and stayed with her. However at my current facility, the protocol is to notify the MD with any BS less than 70. So if it was that low, I'd start the hypoglycemic protocol and have someone call the doctor at the same time.
    CountyRat and jadelpn like this.
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    If the patient is A&O juice is a fine intervention, with a bs check after. Keep a close eye on the patient and recheck the sugar-- with juice it can and does then go quite higher after some hours. Hence why you never want the patient to get into a cycle of treating low blood sugars day after day. It could be an indication that the patient's diabetic medication needs to be tuned. Always call the MD for blood sugars that low (after the intervention). I have never seen a person die from a low blood sugar. I have seen seizure activity, passing out, that type of thing. And that is not usually the best circumstance for a patient to go home and try to live an active life with, and they need to be able to manage their diabeties when they leave your care. I have seen people criticially ill from too high a blood sugar. In the longer term, it is of note that if you are getting lots of lows or lots of highs the MD needs to re-assess what the person is taking for medications and how much, as well as a re-assessment of sliding scale and long acting insulin doses if they are on this medication. As far as D50, it would depend on your protocol, and if the person is unable to eat or drink anything.Not to mention that there's IV dextrose, and oral dextrose. Oral dextrose is similar to giving juice. When someone is unable to swallow due to their blood sugar, then you get into IV stuff that needs an MD order. And OP become familiar with your protocol, or ring for assistance of your charge nurse. In your original post you mention that you "think" that such and so is protocol. If you don't know for certain, ask for assistance. And always be familiar with your protocol as the above poster stated--some facilities require a call to the MD for any sugar less than 70 every time--and have hypoglycemic protocols to follow. But ask for help.
    MedChica likes this.
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    The patient is a known diabetic so I can almost guarentee there were orders on the chart for this situation. Were they on sliding scale insulin? If so the scale also includes what to do for lows, at least at our hospital. If not specific patient orders the hospital would have a policy.

    I would have done what you did. Just make sure they follow with breakfast or whatever meal to keep the sugar up. A quick sugar fix = a quick sugar drop when it wears off. Definitly give them some longer lasting carbs. That is a problem with a dose of D50 too! I wouldn't give IV sugar if you have an alternative...it's so hard on the veins!
    MedChica likes this.
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    What if the patient were NPO for a test but the blood sugar was around 50? Or what if the person had a gtube? At 39, would you put o.j. through the tube or do the d50?

    Our policy is juice (don't add sugar) and recheck in 30 minutes. If unable to eat/drink then do d50. Our policy doesn't go into the ifs....

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