Low blood sugar, juice or D50?
- 0Last 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.)
- 3Apr 17, '10 by BluegrassRNI would have done the same as you. It's easier to do the D50, from the nurse's perspective. You know your patient is getting it, you don't have to trust your patient to drink or eat. Maybe it's a control thing with your fellow nurse.
I think it is terribly rude and presumptive, though, to override a type I diabetic's decision about what to use to bring up their blood sugar. Like you said, they know their body best, and they know what works best. I work with several type ones, and one of my closest friends is a type one diabetic. If they were low, were dealing with it appropriately and how they wanted to deal with it, and a nurse came in trying to give them D50 despite their wishes, that nurse is going to end up with D50 shoved where the sun don't shine.
The only thing I would have done differently in your case would be to recheck her blood sugar, so that you could have definitively reported where she was. And even then, that depends upon the time frame. Next time, check your protocol, as you sounded unsure of what exactly it is. Our is to give juice, graham crackers and peanut butter, or the equivalent if the pt is alert and able to swallow, or to give D50 if the patient is not alert or able to swallow. Blood sugar is to be rechecked every 15 minutes until above 70.
- 0Her BS was going to be rechecked. It just wasn't in the timeframe yet. That's why I went to tell the other nurse what I'd done, so she could re-check her in a few minutes.
I wasn't unsure of what to do until the other nurse said, "I'll get D50". Everything I've seen regarding the protocol is to give juice, etc if they can eat, which is why it really surprised me when she said that. Even the other nurse with her said, "Aren't we just supposed to give them juice if they can eat?" (She isn't the most confident nurse, so her statement didn't necessarily re-assure me.)
This was one of those, the more I thought about it after I got home moments.
And I'm not really sure how this particular patient would have reacted if the nurse had come in with D50. She seems to LOVE being a patient, IYKWIM. Nothing "normal" works for her, in her opinion. She was very happily chronically ill, with all kinds of weird reactions to meds, etc. She might have loved the interevention of using something IV...LOL....Or she might have reacted like you said.
- 0Apr 17, '10 by oramar GuideIf your protocols allow for handling the situation that way fine. However, perhaps that other nurse worked at places that had doctors that have their own protocols that specify D50 for a 39. I know some endocrinologist that would be furious if you didn't follow their protocols. I actually had my fellow nurses raise an eyebrow when I was following hospital protocol and nudge my memory by saying "ah, that is a doctor SMITH patient". I was glad they did because Dr. Smith was a real bear when someone followed the hospital protocol instead of his. Confusing yes, but we got used to it after a while.
- 0Apr 17, '10 by supernaturalWe 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.
- 18Apr 17, '10 by southern rnQuote from supernaturalI'm sorry I will have to disagree with you on this. I have seen MANY,MANY patients over the years with blood sugars this low and lower.It is certainly low enough to cause lethargy but not coma, and to say that most people end up dying from a blood sugar of 39 is simply not something I have seen. OP, If in doubt check your protocols or the patients orders on how to treat;in the scenario you just describe dI would have done exactly the same thing you did. If she didn't respond to food or got more symptomatic then certainly go ahead with the d50.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.
- 2Apr 17, '10 by leslie :-Dfirst, you really need to check your facilitie's protocol, regardless of pt loc.
using nsg judgment, it makes a whole lot more sense to give sweetened juice/drink to those able to drink it.
but you need to stay with them and recheck it...that is also good nsg judgment.