Calling diabetes experts

[Libby1987]

There's a thread where I have a question re diabetes mgmt that I don't think will get answered as it's off topic and buried in the thread so..

If a patient is controlling their type 2 with diet alone, not taking any diabetic meds, is asymptomatic but has a glucose of 70-85, is the proper thing to treat with juice?

With the same scenario, how is the patient at risk of developing critical hypoglycemia if not treated with juice?

Would juice cause an insulin spike in an insulin sensitive diet controlled type 2?

[Pangea Reunited, ASN, RN]

I don't know how usual my experience is, but I find that patients with marginal glucose levels who get put to bed that way are often critically low in the morning. I would give a snack if this was their PM accucheck ....although I'd try to make it part protein instead of all juice.

I also tend to ask the patient how their blood sugars run if the patient is able to participate in his or her care.

[Libby1987]

I don't understand how they become critically low if they're not taking any meds, or have any other contributing condition. It seems to me the juice would cause more of a problem than it would help.

[MunoRN, RN]

70-85 is a normal BG level. The ADA defines hypoglycemia as being less than 70, and recommends intervention when

[Libby1987]

MunoRN, that's what I thought but multiple posters are saying that it is protocol in their facilities to treat those levels with juice.

[MunoRN, RN]

MunoRN, that's what I thought but multiple posters are saying that it is protocol in their facilities to treat those levels with juice.

As a flat rule, that's a pretty silly protocol. Current recommendations say to keep BG between 110 and 180 when controlling BG with interventions, but they don't recommend interventions to push it back up to 110 if it's still greater than 60 or 70, it should be allowed to passively come back above 110, otherwise you're going to start yo-yo-ing.

Given additional context there may very well be good reason to treat a BG of 85, such as if they just started on a long acting, they were 150 and then ate a meal and are now 85 you could reasonably assume they are going to continue to drop, so you're not really treating the 85 as much as the 40 it will be in another hour.

[mmc51264, BSN, MSN, RN]

We treat

[Libby1987]

This is part of the description that posters are saying that they would have also treated with juice..

A good example is that my wife is a diet controlled type 2. (diabetic) She was on glucose checks AC and HS. At HS she was 85. That was at 2100. I left to go home at 2300. When I arrived at 0700 I found out that the night nurse treated her low sugar.... This blew me away.. I asked her why she would treat some one with a normal blood sugar and on no hypoglycemics, and asymptomatic........ I honestly think she did not even understand the question.

[Been there,done that, ASN, RN]

FIRST rule is do no harm.

To Hades with protocol.This is where we apply nursing judgement.

[defying.gravity]

If baseline and history is available, I'd look at that and see how those numbers compared to her baseline. I'd watch for trending if she's getting treatments or her health concern might be affecting her normal baseline .. corticosteriods, infection, etc. I wouldn't treat anything that was baseline for her, if it were me. If your hospital policy says to treat it in that range, I'd make sure that included diet controlled diabetics. I'd run it by her primary for future if her levels were dropping and spiking out of her normal range. If she's asymptomatic, I'd be more interested in the trends. Whatever treatment she was getting would have a big influence in how I viewed the numbers.

[mmc51264, BSN, MSN, RN]

To Hades with protocol.This is where we apply nursing judgement.

Be careful with that one.

[Been there,done that, ASN, RN]

Be careful with that one.

Hades.. or nursing judgement?