Calling diabetes experts

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.

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.

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

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, 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.

We treat

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.

FIRST rule is do no harm.

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

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.

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

Be careful with that one.

Be careful with that one.

Hades.. or nursing judgement?

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.

Yeah, the important thing about this patient is that she's not taking any antidiabetics. While it's true (for instance) that your body produces less glucagon at night, making most people more sensitive to insulin, in T2DMs the alpha cells still respond to insulin levels and produce glucagon on demand (such as when beta cells stop producing insulin in response to hypoglycemia). So, there's really no reason to assume her blood sugar will drop over night unless we have reason to suspect inappropriate insulin production (e.g., an insulinoma).

Also, an infection or corticosteroid is likely to raise her blood sugar, not drop it.