Hypoglycemic Nursing Student

  1. I need some help. I am starting my clinicals in the fall and am worried about it. I have had 2 doctors tell me I am hypoglycemic and one NP tell me I am not. I feel I am because you dont normally just pass out on the floor when you havent eaten in 3 hours for no good reason. I have only passed out once from low blood sugar, but get very dizzy and shaky at times. I try to eat a balanced diet and exercise, and that helps, but I still get it some times. I also pass out when I get nervous (I passed out at my own wedding. Not just a little woozy and slumped to the floor, but I just WENT DOWN in a second and went totally out for a good 4 minutes.) I told my NP about this and she didnt seem at all concerned.

    My question is, how do you handle keeping blood sugar up while on 8-12 hour clinicals??? I have tried using hard candies,but that just makes me worse within an hour. And it doesnt do me any good to eat a big breakfast, because I will still need something in a few hours to keep it up. I am very worried about this, and my biggest worry is passing out during a clinical. If I mix low blood sugar with nervousness, I guaranteed I'll pass out at least once. I"m not sure how to handle this.
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  2. 15 Comments

  3. by   talaxandra
    I'm more concerned about what's going on with your endocrine system than how you'll go in your clinicals - unless you're taking hypoglycemic medication, blood sugars low enough to manifest like this are a sign of something else going on.
    Do you do okay overnight, or do you need to eat frequently then, too? Did either of the doctors who said you were hypoglycemic do any kind of follow-up? Recommend testing? Check what your blood sugar level falls to?
    Please consider investigating this further. In the meantime, high-sugar foods like lollies will cause a rebound effect like you describe - you're better trying complex carbohydrates like plain biscuits or bread/toast, which have a gentler and more sustained effect.
    Good luck!
  4. by   purplemania
    agree with above post. You need to get to the bottom of your problem. Meanwhile, as a diabetic working 12 hr shifts I will tell you that I keep crackers, peanut butter and fruit in my locker or even my pocket. I do not eat three times a day---more like 5-6 times. I spread out my calorie intake but make sure there is a complex carb every few hours to keep my energy up. Check with the Am. Diabetes site. You will find that the diet for hypers is the same as for hypo's. The objective is to balance carbs, protein, fats with exercise. GOOD LUCK Hey, have you talked to a dietician yet?
  5. by   prairiegirl
    The doctor who told me I was hypoglycemic diagnosed it based on symptoms and that when I passed out, as soon as I had some OJ I was much better. She did not do blood work because at the time I had no insurance and could not afford it. She just said to eat every few hours. The NP I see now at my university's wellness center said I did not have hypoglycemia. She only did regular blood work (she was originally checking my thyroid), but she got glucose levels too. She took my blood right after I had ate lunch (PBJ, peach, and yogurt). My blood sugar was 72. She said that was normal, but it sounded low to me since I had just eaten. But I did some research and it said that unregulated hypoglycemia can lead to diabetes later on. My family has a history of developing type II diabetes after age 50 in the women (maternal side of my family). Most of them were also not overweight at all when they developed it. I am also concerned because I have put on 40 pounds in the past 2 years and I cannot lose it. I workout every day (cardio 5 days a week for at least 45 minutes and weight training 2 days a week for 20 min) and I eat healthy. But my weight will not budge. That kind of put of a flag to me that something might be wrong.

    I have to got for my nursing school physical in 2 weeks, so I will bring this problem up and maybe suggest I have a glucose tolerance test done.
  6. by   prairiegirl
    Quote from prairiegirl
    The doctor who told me I was hypoglycemic diagnosed it based on symptoms and that when I passed out, as soon as I had some OJ I was much better. She did not do blood work because at the time I had no insurance and could not afford it. She just said to eat every few hours. The NP I see now at my university's wellness center said I did not have hypoglycemia. She only did regular blood work (she was originally checking my thyroid), but she got glucose levels too. She took my blood right after I had ate lunch (PBJ, peach, and yogurt). My blood sugar was 72. She said that was normal, but it sounded low to me since I had just eaten. But I did some research and it said that unregulated hypoglycemia can lead to diabetes later on. My family has a history of developing type II diabetes after age 50 in the women (maternal side of my family). Most of them were also not overweight at all when they developed it. I am also concerned because I have put on 40 pounds in the past 2 years and I cannot lose it. I workout every day (cardio 5 days a week for at least 45 minutes and weight training 2 days a week for 20 min) and I eat healthy. But my weight will not budge. That kind of put of a flag to me that something might be wrong.

    I have to got for my nursing school physical in 2 weeks, so I will bring this problem up and maybe suggest I have a glucose tolerance test done.

    I forgot to add. I do eat at night alot or I feel nauseated. If I dont eat before bed, I wake up dizzy and nauseated. All of my symptoms were much worse while I was on BCP. I quit them when i got married, and it is a little better. My symptoms always get worse the week of and week after my period. Dont know if that means anything or not. I"m just tired of it. And I cant lose weight because I have to eat all the time. If I cut my calories down to 1500 a day, I get weak and dizzy feeling when I workout. By they way, I am about 15 pounds overweight or maybe 20. I am 5'7" and 165 lbs. This whole thing just has me feeling like crud.
  7. by   talaxandra
    Let me preface this by saying that I am a bit of an alarmist - every headache is a tumour, every wound's necrotising fasciitis! However, the fact that you have put on weight while actively trying not to, and that you wake with symptoms, are strong indicators to me that there's something going on. True hypoglycaemia (to the extent you describe) is not normal. It may be (and this is where the caution about my alarmist nature comes in) that you have an insulinoma.
    Kind of the opposite of diabetes, an insulinoma is a benign tumour which releases insulin. They're rare, and accordingly often take a long time to diagnose (one of my patients was symptomatic for nine years before he was referred to an endocrinologist).
    Like I said, it may be that I'm over-reacting, but even if it's something else you really need to find out what's causing this. Good luck
  8. by   Lys
    Hey prariegirl,

    I have almost the same problem as you...my dr did a longer form of glucose testing that you may think about having done (when you have the $$). It's a baseline + postprandial test, but you go in after a night of fast, have a blood draw, go home eat, come back 3hrs after eating to determine if your bg has fallen since you've eaten.
    Mine showed that it was fine fasting but 1.7 mmol/L after eating (they're screwy canadian units, normal is 3.9 - 5.6 mmol/L), which I would class as "I should not be standing" but my dr (who is the complete opposite of concerned for my health) said she didn't know normals and therefore wasn't worried. *shakes head* So needless to say she hasn't done much in way of treatment or consultation.

    Anyway...based on what's worked for me, I think you're doing all the right things. One tip that saved me a lot of times, when thinking of a snack...think high fibre. Also carb + protien works well (i.e. whole wheat crackers and PB or cheese).

    If you do figure out what's causing your troubles, do keep us posted :-)

    Best of luck!!

    Lys
  9. by   suzanne4
    Quote from prairiegirl
    The doctor who told me I was hypoglycemic diagnosed it based on symptoms and that when I passed out, as soon as I had some OJ I was much better. She did not do blood work because at the time I had no insurance and could not afford it. She just said to eat every few hours. The NP I see now at my university's wellness center said I did not have hypoglycemia. She only did regular blood work (she was originally checking my thyroid), but she got glucose levels too. She took my blood right after I had ate lunch (PBJ, peach, and yogurt). My blood sugar was 72. She said that was normal, but it sounded low to me since I had just eaten. But I did some research and it said that unregulated hypoglycemia can lead to diabetes later on. My family has a history of developing type II diabetes after age 50 in the women (maternal side of my family). Most of them were also not overweight at all when they developed it. I am also concerned because I have put on 40 pounds in the past 2 years and I cannot lose it. I workout every day (cardio 5 days a week for at least 45 minutes and weight training 2 days a week for 20 min) and I eat healthy. But my weight will not budge. That kind of put of a flag to me that something might be wrong.

    I have to got for my nursing school physical in 2 weeks, so I will bring this problem up and maybe suggest I have a glucose tolerance test done.
    Blood sugar 0f 72 is not normal after eating a peanut butter and jelly sandwich as well as a peach. If you made it on white bread then that is converted to simple sugar and causes your blood sugar to rise even more.
    I would definitely recommend a work-up to find out exactly what is going on............ also you usually do not diagnose hypoglycemia just on symptoms...that alone requires a workup.

    Good luck and please let us know what they find-out.............
  10. by   flowerchild
    Quote from prairiegirl
    I need some help. I am starting my clinicals in the fall and am worried about it. I have had 2 doctors tell me I am hypoglycemic and one NP tell me I am not. I feel I am because you dont normally just pass out on the floor when you havent eaten in 3 hours for no good reason. I have only passed out once from low blood sugar, but get very dizzy and shaky at times. I try to eat a balanced diet and exercise, and that helps, but I still get it some times. I also pass out when I get nervous (I passed out at my own wedding. Not just a little woozy and slumped to the floor, but I just WENT DOWN in a second and went totally out for a good 4 minutes.) I told my NP about this and she didnt seem at all concerned.

    My question is, how do you handle keeping blood sugar up while on 8-12 hour clinicals??? I have tried using hard candies,but that just makes me worse within an hour. And it doesnt do me any good to eat a big breakfast, because I will still need something in a few hours to keep it up. I am very worried about this, and my biggest worry is passing out during a clinical. If I mix low blood sugar with nervousness, I guaranteed I'll pass out at least once. I"m not sure how to handle this.
    I have a history of hypoglycemia, so does my Mom. I have learned to keep my sugar up b/c once it goes down it takes me several days to level it out again. Using simple sugars and simple carbs only works for the short term - like 30 mins or less. It's a temp fix just to give me some time to eat real food. I took a nutrition class last year and learned that it's not how much I eat but what I eat. A simple sugar carb lasts a short time, complex carbs a couple of hours, and protiens give me energy and keep my sugar up the best. If anyone eats a bowl of sugared cereal for breakfast, it's benefit is gone in just a couple of hours. Have an egg or two and some bacon or ham and it sticks around for about 4 hours. The trick that works for me is to not let my sugar go low in the first place. Listen to your body and do what it asks. I admit I sip on sugar drinks most of the day which keeps my sugar up during the day. Then I make sure I never skip a meal and provide myself with as much protien in my diet as I can to make it to the next meal. I carry crackers and PB too but if I need them It's too late. I've already bottomed out and, like i said takes a few days to level it back out again. I hardly ever take my own BS b/c I already know when it's low by how I feel and I already know what to do to straiten it out so what's the point in pricking my finger? Experiment and find what works best for you. I'd telll you to eat small frequent meals but this will probably not work in nursing. It never worked for me. That's why I learned to keep those sugars up via proper foods that allow me to go several hours without eating. Also, if I'm working really hard, I eat more to compensate for the energy spent. If I'm not very active, I eat less. Just remember to let your coworkers know that you are hypogly and that way if you pass out they will know why and be able to help you better. Good luck to you.
  11. by   flowerchild
    BTW, prairiegirl I'm exactly the same height and weight you are. It's hard to keep the weight down sometimes. Dieting is a tricky thing to do. I just watch my protien portions to help keep the wieght down. I absolutly avoid diet drinks and other diet products b/c they are useless to me, I do better without them, my sugars stay level better without the diet products. I think my weight gets out of hand more often when I give in to the sugar/sweet cravings. My sugar levels don't do well after donuts! Avoid them and the like and keep the sugar drinks down to one or two a day.
  12. by   RedSox33RN
    I'm diabetic and have a BIL that has severe hypoglycemia. Actually, eating sugar will bring your bs up, but it is not recommended for regular meals. If you have true hypo, you need short and long-acting carbs, as well as protein and fiber, which will offer more stability in your bs. Candy and simple sugars will bring it up quickly, but you will fall just as fast when they are gone. Truly, you should see an endocrinologist, and then probably a dietician.

    You should also carry a glucometer, and get into the habit of checking as a diabetic would. Especially before driving (I don't drive with a bs less than 100).

    But I agree that you should find out what is going on first. Many docs and NP's can miss the diagnosis. I had two docs miss my diabetes, and this was WITH high blood sugars, and a history of 2 pregnancies with GD. You really should see a specialist.
  13. by   LPNweezy
    keep a protein/ nutrigrain bar handy at all times!! ALWAYS make time for breakfast. drinking coffee will help too. make sure to eat when you are hungry, don't neglect your self

    good luck in your schooling!!!
  14. by   threelittlebirds
    I too have a family history of hypoglycemia...you're not alone! I'm a junior in my program, and we have 12 hour clinicals. I was initially really nervous (I usually eat at least every two hours!), but found that if I'm careful, it's pretty easy to regulate my blood sugar. First, stay REALLY hydrated. Seriously, every time you're not in a patient's room, you should be drinking as much water as you can! Second...try swapping out the simple sugars with complex carbs, protein, and fat. Before I go to clinical, I have a big bowel of grape nuts and whole milk and coffee with whole milk...for some reason, the combination of fat and protein and sugar in whole milk (as opposed to skim or fat free, which make me crash later) really regulates me. For my lunch break, I try to bring either quinoa or brown rice with black beans and cheese. Delicious, and my blood sugar doesn't plummet a half an hour later. I also try to keep a stash of emergency almonds in the break room (you might want to keep them in your scrubs just in case) to snack on if I'm feeling low.

    I agree that you should be working with your doctor to make sure there's not something else going on...but you could be like me, just running low with no real explanation. If that's it, you just need to learn to self regulate. Everyone's body reacts differently to foods, so you need to find what works for you! And if you start feeling dizzy- just sit there's no shame in passing out, as long as you don't endanger a patient.

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