After Hypoglycemia

I know my work has a hyperglycemia/hypoglycemia protocol. Every hospital should have one. It will tell you how often to recheck and exactly what to do. Your hospital should have one. Just ask one of the nurses to print a copy for you. This way you know exactly the steps and the timing needed to be sure you are providing optimal care.

I have two diabetic children both type 1 on insulin so have lots of personal experience with this. Some people are more prone to hypoglycemia than others and one of the problems is some people have what's called hypoglycemic unawareness where they don't recognize the symptoms right away or at all. Long term suggestions would be to ask the patient if they usually recognize symptoms of hypoglycemia, to describe how they feel when their blood sugar is low, if they have had episodes of needing assistance to treat hypoglycemia before, and how many episodes of hypoglycemia they've had in the past 30 days. These are all questions we are typically asked at endocrinologist appointments. Not sure if this helps any at all, but this might give you an idea on what symptoms to look for in the patient as symptoms of hypoglycemia vary a little from person to person and you might be more aware to check on the patient if they are very prone to hypoglycemia. I am still a student, but figured I'd throw my thoughts out there.

What time was the blood sugar taken in relation to when you gave the sliding scale? Did the patient have anything to eat? How long after the insulin administration did they have the hypoglycemic symptoms?

In many cases, there's nothing you can do to prevent an unexpected drop. But knowing what time your insulin peaks in the blood stream and checking on the patient around that time might allow you to notice the early signs of hypoglycemia.

Your facility should have a protocol, and I'm just a student (and a Type 1 who has been sent hypo in a hospital from a doctors insistence that I be given a sliding scale that was waaaayyyyy to high, back then I did not know I could med refuse). Protocol for a diabetic post hypo is generally 15, 30, and 2 hours. That's what I've been taught by every endo and CDE. A good rule of thumb is to ASK US (the diabetic) what we would do at home. I always love the nurses who ask me.

Thank you for the responses. This happened in the morning around 7:30 am - the patient already had his breakfast in front of him but I did later find out his appetite hasn't been good lately but we were still using the same sliding scale on him that is normally used in the nursing home he lives at. Of course after the hypoglycemic incident the doc changed the sliding scale. I was told what to look for immediately following the event, but not much about potential longer lasting effects.

the lesson from this --- every pt is different. Plan for the worst and pray for the best

And if they didn't wipe the alcohol from the finger before sticking the patient, it might not have been a 400 at all....I usually double check anything that odd by first checking previous sugars (does Pt X usually run that high?) and then retaking the fingerstick.

One of my clinical instructors taught me to always double check a blood sugar over 300 and under 60. That stuck with me and I still do it that way as a RN.