Opinion re: managing low blood sugar? - page 4
With all the knowledge and experience out here, I'd like you folks' opinion regarding the following scenario: I was day charge over this past weekend on my floor (Med/Surg-Tele). In taking report... Read More
Jan 14, '06If the nurse felt the need not to follow protocol, she should have called the physician.
May have needed an incident report done from day nurse the second time.
Interesting discussion, this must happen everywhere.
Jan 14, '06We have glucose gel or glucose tabs for conscious patient but they hate taking them so we usually end up giving OJ, followed by graham crackers with peanut butter and/ or milk. We then retest in 15-20 min. After the second incident I would have wanted to ask what the patient had to eat the evening before and if any insulin was given. If I see a pattern of low AM scans I make sure the pt gets a protein snack at bedtime, especially if insulin is given at noc. 4-8 oz of skim or 2% milk and a couple of graham crax with maybe a thin spreading of peanut butter can stablize the glucose level overnight.
Jan 14, '06i've seen orders that state to call md w/bs <70 or >400, w/no ss orders.
one time, i had a diabetic pt whose 6a bs was 33; she was diaphoretic, unarousable-called the md stat-no call back. i took choc syrup and administered it intrabuccally as well as sl. when she started coming to, i gave her a few spoons of ice cream and then finally a cup of milk. 1/2 hr later her bs was up to 74. i called the md x3; it took him over an hr to call back.:stone
from that experience alone, whenever i deal with an iddm pt, i make sure that i have orders from ea md for tighter parameters for low bs's and ss orders for hyperglycemia.
Jan 14, '06I've always seen food given before D50...as long as the patient has a gag reflex and can eat and drink without difficulty. I've always seen something fast acting like juice to bring up the blood glucose quickly, followed by a carb and protein combo like peanut butter and crackers, cheese and crackers, or a hard boiled egg and toast.
D50 seems pretty drastic...it is pretty hard on the vein and nasty if it infiltrates...it also has the same rebound effect that adding sugar to juice has if not followed with a complex carb and protein soon after administration.
Years and years ago, our diabetic educator talked about the rule of 15s or something like that...it was something about giving 15 grams of carbohydrate, followed by 15 grams of protein and blood glucose should go up 15 points in 15 minutes or something like that...