Low blood sugar, juice or D50?

Specialties Endocrine

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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 did the following....

She was alert, oriented, walking, talking, etc. (She was diaphoretic and seeing black spots, but very capable of eating and drinking.) I got her OJ, crackers and peanut butter. She also had Glucerna at her bedside. She drank the OJ, insisted on drinking the Glucerna too. (Type I DM for 16 years. I often trust what they say since they've been managing their disease for a long time.) She said she'd eat the PB and crackers too. Said she was starting to feel better and I could tell she was "perking up".

I felt confident she was doing better, found the other nurse who had just finished report, and told her what I'd done. She said, "I'll get her an amp of D50."

So with a BS that low, what would you have done? I think our policy is to give food and juice if the patient was able to eat, not NPO, etc. There is no "low end" as far as I know to always give D50. Does it work faster? With a BS of 39, would you use D50 even if the person could eat?

This has been bugging me all night. I actually had a dream that they called an RR on her after I left. (Very odd-ball patient, probably undiagnosed bi-polar or personality disorder. She'd taken up A LOT of my time that day and had gotten under my skin, which is probably why she was so much on my mind.)

Specializes in Cardiac, ER.
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.:eek:

I 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.

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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....

I 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.

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.

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Specializes in critical care.

So, what is the deal with Glucerna? Is it any good for hypoglycemia? I get that it might be good to give to keep the patient from dropping again, but would you want to give it right away, along with juice?

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Surely, you cannot believe that most people die with a bs of 39. Having been a type 1 for almost 20 years, I can tell you that my sugar hits the 30s at least one a month, and I am still kicking. Guess I have hundreds of lives or perhaps great luck?

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Specializes in retired LTC.

After reading all the responses, I think you all are talking acute care/hospital. In LTC, I've had to fight to have appropriate snacks and juices avail. Some places only supply that phoney orange-aid punch. And good luck trying to obtain any substantial sandwiches; sometimes even sugar packs are a bene-luxury.

Some places are better than others; some lock up their kitchens at 7pm (supervisor may or MAY NOT have a key). Don't get me started on food availability for 11 - 7 shift's early send-outs, like dialysis, hosp ORs, etc.

But if I get a really brittle diabetic, I get a prn glucogen order. I also ensure the availability of glucose jelly (even if I keep my own supply). I personally check for all the meds, glucometer supplies, etc so I know my 11 - 7 staff can manage low BS episodes; and they have all become very proficient doing so. I worked with a diabetic nurses who was a stickler for other diabetics, so I guess part of her rubbed off on me. (Thank you LD!)

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Specializes in ED, ICU, lifetime Diabetes Education.

I'm late to this but my advise as coming from a critical care/ED and type 1 diabetic is if the pt is alert & oriented, can answer questions appropriately, and cooperative give them the oral treatment of juice, crackers and protein. At a level below 50 mg/dl I would give them the equivalent of 30 grams of fast acting carbohydrates and add some protein. If the pt is not cooperative, confused or uncooperative, then I would go right for the D50 or glucocon. The pt will forgive you afterwards. =-)

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Specializes in ER, progressive care.

Does your hospital have a hypoglycemia management protocol? Typically if the patient is awake and alert and not NPO, you go ahead and perform a "rescue intervention" by giving them 15gm of carbohydrate. If they are NPO and/or not alert, then you go with the amp of D50. If they didn't respond to the rescue intervention, I would have grabbed the D50. You need to recheck the blood sugar, though. Our protocol is within 20-30minutes after performing a rescue intervention.

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the pt handed off to me just came from the MICU , confused at baseline, poor po intake had a BS of 69 from prior shift was given only oj bec of refusal to eat.went up to 83, got handed over to me and random BS check at midnight was 69 again, pt refusing glucose tabs and oj at this point, so I asked for d50 order which the hospital didn't carry, we only had d10. was able to get pt to chew on 1 glucose tab and sip on oj afterwards. rechecked and was 89. For me, having no d50 as a prn or on stock is very weird. in cases of BS <50with changes in LOC,or emergent cases, I would've preferred having d50 than d10 in 250 ml+time wasted on priming line for bolus.the charge nurse looked at me and said this was not necessary. I personally think having a BS that's continually maybe slowly going down is something to pay attention to and prevent any real glucose emergencies overnight or early am.

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Specializes in orthopedic/trauma, Informatics, diabetes.
On 4/17/2010 at 11:17 AM, DuluthMike said:

If the patient can tolorate juice, go with that. There is no reason to administer D50. D50 is not benign.

If I have a pt that has a BG of 39, I'm giving a full amp of D50. Don't understand what you mean by "D50 is not benign" It's 25g of carbs. It is not going to harm pt and it gets BG up quickly while some protein is gotten.

With what OP did, was perfect, juice then other food to keep it up. The other nurse waited too long to treat. After the pt had eaten and drank all that she did, she should have been fine. We test within 30 min of treatment and then test/treat until pt has a BG >80 for an hour.

For hyperkalemia, we give 2 full amps of D50 sometimes.

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Specializes in Critical Care.
On 1/30/2020 at 4:52 PM, mmc51264 said:

If I have a pt that has a BG of 39, I'm giving a full amp of D50. Don't understand what you mean by "D50 is not benign" It's 25g of carbs. It is not going to harm pt and it gets BG up quickly while some protein is gotten.

With what OP did, was perfect, juice then other food to keep it up. The other nurse waited too long to treat. After the pt had eaten and drank all that she did, she should have been fine. We test within 30 min of treatment and then test/treat until pt has a BG >80 for an hour.

For hyperkalemia, we give 2 full amps of D50 sometimes.

D50 is extremely caustic and poses a risk of harm which should be justified by having no safer alternative available. We had a patient in my ICU that expired immediately after receiving D50, they were an ME case which determined that the cause of death was a global MI resulting from the administration of a caustic sclerosing agent (D50).

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Specializes in orthopedic/trauma, Informatics, diabetes.

Can you send me some links? Please? I don't work at some mom and pop hospital. Everything is EBP, top tier. Never had I head that D50 is "caustic" What do you use for the treatments I listed?

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Specializes in Critical Care.
On 2/8/2020 at 6:47 PM, mmc51264 said:

Can you send me some links? Please? I don't work at some mom and pop hospital. Everything is EBP, top tier. Never had I head that D50 is "caustic" What do you use for the treatments I listed?

https://www.aliem.com/d50-vs-d10-severe-hypoglycemia-emergency-department/

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