Low blood sugar, juice or D50? - page 4
by mappers | 19,848 Views | 42 Comments
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
- 2Aug 15, '12 by CountyRatIn my experience, patients who have had diabetes for many years usually get very good at knowing when they need sugar, and when oral sugar is adequate. As for juice vs. D50, I always prefer the less invasive (in this case oral) option so long as it is reasonable and safe. I would have done as the OP did. However, I also agree with those who advocate rechecking the BS soon after treating hypoglycemia. In fact, any time we intervene in a potentially critical event, we should reassess, whether it is the scheduled time or not.
- 2Aug 15, '12 by uRNmywayI think it depends on your institution. Check your policies and procedures manual. Where I have worked, doesn't matter how low the BS is, if the patient is responsive and able to eat, you feed them. Start with the sweetened juice, Glucerna, whatever it is. Then recheck your BS. Once it is stabilized, you offer some kind of proteinated snack, like cheese, milk, yogurt, etc. for longer term BS maintenance. If however at any point your patient becomes unresponsive, that is when you would push the D50. And I should mention, if the BS was below a certain level, the MD was to be informed ASAP. Then I guess you follow the MD orders.
But again, that is for where *I* worked. Check your P&P manual.
- 5Aug 15, '12 by uRNmywayQuote from supernaturalWait, WHAT?! I have seen several patients with BS in the 20's and they came right back up with snacks. None of them died. Most were still responsive. I have no clue where you got that information.We give an amp of D50 then call the MD it is protocol at our hosp. People can go into a coma a die at that low of a BS. Plus most people end up dieing with sugar that low. An amp of D50 should have been first. Then a page to the MD with a recheck on the BS. If that patient went into a coma or died you could have been held medically liable for your actions.
- 5Aug 15, '12 by nursemikeGot curious one night and read some labels. Amp of D50 and 4oz OJ are very similar amounts of carbs. Don't add sugar to the OJ, it's overkill. And D50 through a peripheral is nothing to be taken lightly. Pretty much everything we do carries risks, but an AO pt who is talking can probably drink some juice. A snack with some protein (PB and crackers, for example) will help stabilize blood glucose.
- 0Aug 16, '12 by nursemikeQuote from GrnTeaThank you. If I could just keep my own A1c in single digits, I'd feel like bragging. I recently treated a pt for "hypoglycemia" of 75 (wasn't dying, of course, but felt crappy) and I was pretty proud of myself when his overnight labs read a glucose of 133, then a.m. fingerstick was 120-something. It has taken awhile, but I'm learning not to drive tacks with a sledgehammer.Aw, nursemike, there you go spoiling perfectly good speculation-fest with actual, like, information. Well done.
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- 0Aug 16, '12 by BrnEyedGirlQuote from supernaturalI work with a nurse that can still walk around and talk at 20,...she has been a diabetic for years and uses an insulin pump. She hates D50 because she goes from 20 to 300 then has to fight to safely get back down. Check your policy. We give oral glucose with a protein snack if the pt is able to take PO then recheck in 30 min.We give an amp of D50 then call the MD it is protocol at our hosp. People can go into a coma a die at that low of a BS. Plus most people end up dieing with sugar that low. An amp of D50 should have been first. Then a page to the MD with a recheck on the BS. If that patient went into a coma or died you could have been held medically liable for your actions.
- 0Aug 16, '12 by FurBabyMom, BSN, RNQuote from eatmysoxRNI would give the D50 and notify the doc - its something that the attending and whatever doc is doing the test / procedure should know. Waking docs up at night I'd only call the attending of there was no on call coverage in house. But it is something I would include with preop / per procedure report so the procedure doc knows about it.So...
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....
The rationale for being NPO for many tests (upper GI, TEE etc) as well as any surgery is that the medications given for sedation (even conscious sedation) can cause differing reactions in patients, one being nausea/vomiting. If there is anything in the stomach it increases the risk of aspiration secondary to the patient throwing up of dry heaving. That is why many patients may take a pill or several pills with a sip of water but nothing else. A container of juice is much more than a sip - so in the interest of patient safety the better choice is the D50.
Edited to add - Otherwise, if not a patient NPO for a procedure I would start with PO juice milk something and recheck the sugar.