Low Blood Sugar. D50?

  1. 0 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!
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  3. Visit  EJSRN profile page

    About EJSRN

    EJSRN has '2' year(s) of experience and specializes in 'med surg/icu/tele'. From 'ny'; 29 Years Old; Joined Nov '08; Posts: 102; Likes: 27.

    12 Comments so far...

  4. Visit  RN1982 profile page
    1
    If the patient was going to be eating breakfast and had no other s/s of hypoglycemia, I would not have given D50 because it isn't necessary. If it was in the middle of the night when the patient would not be eating a meal, I would give orange juice and some crackers. It's not necessary to put extra sugar in the orange juice either as the carbohydrates in the juice and crackers is sufficient enough to raise the blood gluicose. I would have called the doctor to discuss perhaps discontinuing the lantus or lowering the dose.
    MoopleRN likes this.
  5. Visit  classicdame profile page
    0
    Lantus does not peak, so that should not be the problem. In fact, it is ofter prescribed to help control hypoglycemia. Lantus is not titrated like rapid-acting and Regular insulin. Changes in doses are done every 3-4 days, depending on FBS. Is the patient also on a rapid-acting insulin or oral medication for DM?

    As for what to do - if your policy REQUIRES you to treat hypoglycemia at a set point, then you ought to do that and check BS frequently, plus call MD. If it is up to you, then you better have plenty of documented blood sugars to show why you did/did not administer D50, patient's intake, length of time to recovery, etc. Some patients do not have low BS awareness, but can still suffer from TIA, MI or other side effects of Low BS. Glad your patient is doing better now.
  6. Visit  KyPinkRN profile page
    1
    Quote from 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!
    I think giving the D50 is jumping the gun a bit... think about it this way. The patient hasn't eaten all night. If alert and oriented it is appropriate to give a snack, my preference is OJ and peanut butter and crackers, especially if it is right BEFORE breakfast. In my opinion this nurse just set the patient up for a roller coaster day with their blood sugar. You probably had to give sliding scale insulin at lunch to offset the high sugar created by giving the D50 and then the patient eating breakfast, which again caused a dip in blood sugar at dinner time. Our policy is to treat for hypoglycemia and see if the the sugar comes up 15 min after a snack is given. If it does we're cool (I usually hold any prandial insulin at that point) if not it's another round of snacks and a call to the doc. We reserve the D50 for patients who can't take PO well.
    RN1982 likes this.
  7. Visit  truern profile page
    2
    A BG of 56 will come up with a snack or breakfast.

    It would take me HOURS to come down from D50.
    Last edit by truern on Nov 19, '08
    RNKel and RN1982 like this.
  8. Visit  SunnyAndrsn profile page
    1
    Had a pt. last night with a BS of 52. It was at meal time, so I documented the low BS, gave him a glass of juice to drink first, and then had an aid sit with him to make sure he ate. BS came up to 139 post meal, I called the on-call and asked if I should give any insulin (scheduled for 8 units--didn't give yet due to hypoglycemia) and got orders.

    Use your nursing judgement, notify the provider, and document, document, document.

    Quote from 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!
    RN1982 likes this.
  9. Visit  Elvish profile page
    2
    If pt is able to eat, I don't ever give D50 for a sugar in the 40s-50s. I try to stick with something that has some protein to avoid another dip as well. D50 sounds like a bit of overkill.
    lsyorke and RN1982 like this.
  10. Visit  NurseyPoo7 profile page
    0
    I thought juice + sugar added by staff was frowned upon now?

    My hospital says just juice is OK.
  11. Visit  ChocoholicRN profile page
    0
    Like the previous posters said, if the patient was asymptomatic and about to eat, I would have just given him/her some OJ and crackers and just keep an eye on their fingersticks. I would not give an amp of D50 for an asymptomatic FS of 50. There was only one time that I did this and this patient was a unique case. She was a very uncontrolled diabetic, admitted with FS of 480 (though not admitted for hyperglycemia), then a few days later was 420, by lunchtime dropped down to 26, symptomatic, and was given D50. By the time I came in, she was back up in the 400's then later was 33. By morning time she was 50 but asymptomatic, but because she was so out of control with her blood sugars I pushed D50 and the next day she was stable during my whole shift!! When in doubt, always ask at least one other person.
  12. Visit  NurseyPoo7 profile page
    0
    By the way, does your hospital have a hypoglycemic protocol?
  13. Visit  radoncrn profile page
    0
    Every institution should have a hypoglycemia protocol that should be followed. You may want to take this opportunity to develop one with your Diabetic Educators.

    Don't let anyone fool you into believing that Lantus doesn't peak....the only place it does not peak is in the drug company literature. That being said.....a life with Lantus and Humalog is far easier that NPH and Regular.

    Just my personal take on the situation.
  14. Visit  nerdtonurse? profile page
    1
    The folks I've seen, D50 usually lifts the FSBS by about 100 points. So, the person would have went from asymptomatic 50's to 150's. I usually only give d50 for fsbs that are symptomatic or if they are asymptomatic and their sugar's less than 40 unless there's something special going on.

    But, as always, follow facility recommendations.
    mandaaRN likes this.
  15. Visit  Medic09 profile page
    0
    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?


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