Low Blood Sugar. D50?

[EJSRN]

I had a pt. at work the other day and he was diabetic. FSBS would fluctuate quite a bit. Before my shift the blood sugar was 56 before breakfast. The patient was showing NO s/s of hypoglycemia. The nurse immediately gave an amp of D50. His blood sugar before lunch was high 200's. I just would like your opinion on this. Personally I would not have done the same thing. When we took his blood sugar before dinner it was 58, and the LPN said "did you want to give the D50 like the previous nurse" again the patient was asymptomatic. I told her no and to give OJ with one packet of sugar in it, and we'll check the level after dinner. And of course I notified the doc that the FSBS was less than 70. It was 92 after dinner. The pt had recieved Lantus (unsure the amt of units) at 1500 before my shift.

Your opinions, and what you would do will help! thanks!

[Medic09, BSN, RN, EMT-P]

I think you did the right thing in the evening.

The corollary to 'treat the patient, not the monitor' is 'treat the patient, not the protocol.' No protocol is an absolute.

IF your facility doesn't allow for you to use your judgement, then you can always call the doc, explain your thinking to them, and see what they say. But I would certainly hesitate to give D50 to a non-symptomatic patient who is about to eat. I would prefer checking a post-prandial glucose and maybe monitoring a little more frequently later.

Was there some special risk to this patient that would make the quick fix of D50 necessary?