Low blood sugar, juice or D50?

Specialties Endocrine

Published

Last night I had a patient with a BS of 39. I had just finished giving report on her when she asked us to check her BS. Since the oncoming nurse still had to get report on a few more patients, I got the aid to check the BS then did the following....

She was alert, oriented, walking, talking, etc. (She was diaphoretic and seeing black spots, but very capable of eating and drinking.) I got her OJ, crackers and peanut butter. She also had Glucerna at her bedside. She drank the OJ, insisted on drinking the Glucerna too. (Type I DM for 16 years. I often trust what they say since they've been managing their disease for a long time.) She said she'd eat the PB and crackers too. Said she was starting to feel better and I could tell she was "perking up".

I felt confident she was doing better, found the other nurse who had just finished report, and told her what I'd done. She said, "I'll get her an amp of D50."

So with a BS that low, what would you have done? I think our policy is to give food and juice if the patient was able to eat, not NPO, etc. There is no "low end" as far as I know to always give D50. Does it work faster? With a BS of 39, would you use D50 even if the person could eat?

This has been bugging me all night. I actually had a dream that they called an RR on her after I left. (Very odd-ball patient, probably undiagnosed bi-polar or personality disorder. She'd taken up A LOT of my time that day and had gotten under my skin, which is probably why she was so much on my mind.)

Specializes in Medsurg/ICU, Mental Health, Home Health.
first, you really need to check your facilitie's protocol, regardless of pt loc.

using nsg judgment, it makes a whole lot more sense to give sweetened juice/drink to those able to drink it.

but you need to stay with them and recheck it...that is also good nsg judgment.

I agree 100%, Leslie. I forgot to mention these things in my post.

Up Vote Up Vote ×
Specializes in Psych ICU, addictions.

Not too long ago, I had a patient with a BG in the 30s...they were AO4, feeling "funny" but denying other symptoms, and capable of eating and drinking. So I gave them some sweetened OJ and some crackers and sat with them while they noshed. It did the trick...a little too well: it was 203 when we rechecked it.

So I would have done the same as you and offered food/drink if the patient was able to eat and then rechecked...I also would have let the doctor know about the 39 right away, and also what the BG was when it was rechecked.

I had a patient with a BG of 14 who was also AO4 and denying symptoms...I strongly suspect that it was a testing error since they were more alert and oriented than most of the staff that early in the morning :) But since they were on bedtime Lantus, we still notified the doctor and they got juice, crackers and a recheck just to be safe.

Up Vote Up Vote ×
Specializes in SRNA.

For a patient who was awake/alert like this one, I would have done exactly as you did.

If the patient also had a decline in her LOC, then D50 for sure.

Up Vote Up Vote ×
Specializes in Med-Surg, Diabetes.

I would have given the juice and a snack too. First of all, the patient was conscious, could swallow and wasn't NPO. Secondly, D50 is pretty rough on a peripheral IV site, so why give it to a patient who could correct her blood sugar by eating snacks.

If I was too busy to stay with the patient after she started feeling better, I'd still keep checking her and her blood sugar periodically to make sure she did not become hypoglycemic again. If the blood sugar came up and stayed up, I don't see any reason to give IV D50.

Up Vote Up Vote ×
Specializes in Emergency, Trauma, Critical Care.

I had a patient A/O, just seemed a little "off" and sweating. Checked sugar: 19, not kidding, lab called when i was about to dbl check blood sugar (to make sure it wasn't an error) stating that the sugar had come back at 28......I decided to forego second blood sugar grabbed 2 OJS and basically have him chug them.

But protocol at my hospital is: if they can take PO and are A/O: give them OJ

If they can't take PO or after a BS check 15 min after OJ is still low: then you give them D50

Recheck again in 15 min: if it's still low, Start Dextrose 10% and Call MD *this is an ICU by the way*

In my personal experience, the OJ somehow works quicker? I never understood that, but I seem to get better results quicker with that.

I would just check the protocol of you facility.

Up Vote Up Vote ×
Specializes in icu/er.

better get on speed with the hospital protocol concerning this, you likely wont get in trouble for for giving juice or amp of d50 and overting the deterioration of a patient, however some bean counter in performance improvement might raise heck & you get canned for not following protocol. ironic....huh.

Up Vote Up Vote ×
Specializes in Family Nurse Practitioner.

Did she actually give the D50 or just get it so it was handy? FWIW I would have done what you did and then stayed with her until the re-test.

Up Vote Up Vote ×
Specializes in med-surg, step-down, ICU/CCU, ED.

x2 what the above poster said. Your intervention was absolutely fine, but I wouldn't have given report on that pt until AFTER I had re-checked the FS. The oncoming nurse had nothing but subjective data to go by so she is probably just trying to cover herself by giving the D50.

Up Vote Up Vote ×
Specializes in Medsurg/ICU, Mental Health, Home Health.
x2 what the above poster said. Your intervention was absolutely fine, but I wouldn't have given report on that pt until AFTER I had re-checked the FS. The oncoming nurse had nothing but subjective data to go by so she is probably just trying to cover herself by giving the D50.

Report was in process when the patient alerted staff of her hypoglycemia.

Up Vote Up Vote ×
Specializes in LTC, Acute Care.

I would have done just as you did. Or sometimes instead of Glucerna I will give a regular Ensure. Working in LTC provides a better advantage of preparation because we pretty well know who is most likely to bottom out and who isn't; so we are able to prepare accordingly. If I'd been in your shoes I would have done exactly the same thing and continued to monitor the patient since she was technically still "your patient" and you'd been with her the whole time. The on coming nurse's task was to simply follow up on the patient after she'd received report and then if further action was needed she could follow up with other interventions.

Up Vote Up Vote ×
Specializes in Med/Surg/Tele/Onc.

Just as an FYI, the patient had been off the floor for awhile. She left frequently to get "fresh air". She had eaten a full dinner before she left (I saw her eating and saw her empty plate.) The oncoming nurse and I were standing outside her room for report when she walked in and told us she needed her sugar checked. We were done with report so the other nurse went to get report from someone else, I got the aid to do the accucheck (I would have done it myself but the aid was standing right there and not busy.) When the aid told me the BS, I immedietly took her the juice, etc. I stayed with pt about 10 minutes, until the other nurse was ready to take over.

I don't know if the other nurse ended up giving the D50 or not. I will review the policy next shift.

PS...to the person who said juice seems to work better thand D50 anyway. I find this with K+. If I give oral K+ it seems to work much better than runs. And runs are sooooo hard on veins, I try to give oral as much as possible if the patient can actually take them.

Up Vote Up Vote ×

our protocol sayd juice and a snack also if the client is able to tolerate it. then recheck, if still low D50 and call md

Up Vote Up Vote ×
+ Add a Comment