Calling diabetes experts

Dogen · Jul 13, 2015

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.

Emergent, RN · Jul 13, 2015

It sounds to me that this patient is doing well with diet improvements. He isn't taking any meds, and has a blood sugar that is a low norm.

I suggest having the patient start leading the diabetic support group. He is succeeding!

Libby1987 · Jul 13, 2015

I think it is frightening the lack of understanding of diabetic mgmt and I think the poster had a valid complaint. However some posters defended the actions of giving juice and stated they would do the same.

Albeit he angered just about everyone with his blanket complaints and I think they went into defensive mode but the juice measure really stood out to me.

KelRN215, BSN, RN · Jul 13, 2015

There's no need to treat blood sugar levels of 70 or 85 in a type 1 insulin dependent diabetic, let alone a type 2 on no hypoglycemics. How would this person become critically low by morning? She was not administered any insulin. There's no reason to do anything.

mmc51264, BSN, MSN, RN · Jul 13, 2015

Back a few posts: be careful throwing protocol to the wind, Not all have the same "nursing judgement" which is why there IS protocol.

RNKPCE · Jul 13, 2015

I bet if you checked, a lot of non diabetics have blood sugars 70-80.

We wouldn't given them juice, so why would you give juice to a patient on a diabetic healthy diet who isn't on anti diabetic meds or insulin. Makes no sense.

A diabetic diet would probably be good for most people.

vintagemother, BSN, CNA, LVN, RN · Jul 13, 2015

Re: defying.gravities post: yes ! Trends are super important!! I observed this as an LVN and have been taught about this as an RN student.

When we watch trends, we can be better be able to determine outcomes.

KelRN215, BSN, RN · Jul 13, 2015

I bet if you checked, a lot of non diabetics have blood sugars 70-80.
We wouldn't given them juice, so why would you give juice to a patient on a diabetic healthy diet who isn't on anti diabetic meds or insulin. Makes no sense.
A diabetic diet would probably be good for most people.

Correct. The last time I had labs checked my blood sugar was 63 mg/dL. My Endocrinologist (I have diabetes insipidus, not diabetes mellitus) was unconcerned.

Twinmom06, ASN, APN · Jul 13, 2015

our protocol is to treat ANYONE with a BG of

RainMom · Jul 13, 2015

Re: defying.gravities post: yes ! Trends are super important!! I observed this as an LVN and have been taught about this as an RN student.
When we watch trends, we can be better be able to determine outcomes.

My personal rule of thumb is to ask the pt!

-- Do you tend to "bottom out" over night?

-- Do you normally have a bedtime snack? Would you like one tonight?

If this isn't a newly admitted pt, I also look at the chart; what were their numbers last night vs this morning?

Libby1987 · Jul 13, 2015

Twinmom, juice in an insulin sensitive person will just drop them again, why not with something like peanut butter and crackers?

VANurse2010 · Jul 13, 2015

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?

No.

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

they're not

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

I'm not an CDE or endocrinologist, but that it seems reasonable that it would.