High glucose levels, everywhere!

sandi1743 · Jan 21, 2011

would you mind defining what you mean by slightly elevated? and what age are we talking about here?

Scooter321 · Jan 22, 2011

Also, what type of patients and which meds are they on. If they're on Solu-Medrol (very common postop) or any other corticosteriod, that's enough right there to raise a person's blood glucose. In my clinical last semester (med-surg) most were on this drug, and we routinely checked the blood glucose because of it, and it was usually elevated. Just a thought from a fellow student. :nurse:

coast2coast · Jan 22, 2011

Also, what type of patients and which meds are they on. If they're on Solu-Medrol (very common postop) or any other corticosteriod, that's enough right there to raise a person's blood glucose. In my clinical last semester (med-surg) most were on this drug, and we routinely checked the blood glucose because of it, and it was usually elevated. Just a thought from a fellow student.

Yup, first thought is steroids. Stress can bump #s up too. Most importantly ... what kind of numbers are you talking about OP?

JROregon, ASN, BSN, RN · Jan 22, 2011

Seems like surgical patients have elevated BS just due to the extra stress on their bodies and the healing process. It's not good to have the BS too elevated though or healing is slowed down. Yes, absolutely, most of these patients are not diabetic prior to their illness or surgical procedure. You'll be able to watch their BS trend downward as their healing progresses. It's pretty cool the way that whole system works.

wombatbullant · Jan 22, 2011

Try cutting out all fast acting carbs, and only use leaner protiens in diet, also get them doing something while they are resting if you can writing reading or something new to them, will help lower BS levels. The newer or less common the activity to the paient the more caleries it will burn. Also be prepaired as they first start to move around will burn up massive amounts of sugar levels, and sudden drops can cause problems in non diabetics.

turnforthenurse, MSN, NP · Jan 22, 2011

Infection, illness, increased stress and surgery can increase blood sugar levels. Corticosteroids can greatly increase blood sugar levels. Other meds, such as beta blockers, can also increase blood sugar levels.

Also take a look at what kind of fluids the patient has going through the IV. A lot of IVPBs such as antibiotics will be mixed with dextrose or the patient might have a whole 1000cc bag of dextrose infusing. Dextrose = sugar, so that raises blood glucose levels as well.

BA_anthropology · Jan 22, 2011

Thanks!! Stress and fluids.

Most of my patients are 1 or 2 days post op.

Yesterday, she was a 70-year-old smoker (deep breathing every hour to keep O2 at 95%, until it dropped to 88% even with deep breathing and was put on O2).

Her glucose was 112 immediately post op and increased to 138 24 hours later while still NPO. At the time the blood work was drawn, indeed she had been receiving antibiotics and dextrose IV. (****Duh!! :banghead: ) She had her IV removed prior to the start of my shift...I'd like to think that's why it wasn't so obvious to me. She complained of discomfort and stress the entire shift, and that she was extremely stressed though out the night and did not sleep.

Mystery solved.

Aside from that, she was not taking any corticosteroids. She was on morphine PCA pump at the time of the draw, and in addition to the antibiotics was receiving colace and vitamin supplements.

JROregon, ASN, BSN, RN · Jan 22, 2011

I was just listening to a podcast from The Nursing Show from Friday (1/21/11) about how blood sugars go up anytime the body is facing stress, you know, like having a test in 2 hours or walking down a dark alley at midnight. Same thing happens after surgery or when you get the flu. The podcast was specifically about stroke and hyperglycemia but can be similar in most acute care situations.

turnforthenurse, MSN, NP · Jan 26, 2011

Thanks!! Stress and fluids.
Mystery solved.
Aside from that, she was not taking any corticosteroids. She was on morphine PCA pump at the time of the draw, and in addition to the antibiotics was receiving colace and vitamin supplements.

Looks like you found your answer :)

From my experience, corticosteroids can really jack up your blood sugar. I have had a lot of patients who aren't diabetic but are on corticosteroids and their blood sugars have been 400+ at times (which at my hospital is considered a critical value, so then we have to draw a green top and send it to the lab...but of course every hospital is different).

It also helps to know why blood sugars can be elevated and why non-diabetic patients still need to have their sugars checked because patients will ask you!

heelhook80 · Jan 26, 2011

Infection, illness, increased stress and surgery can increase blood sugar levels. Corticosteroids can greatly increase blood sugar levels. Other meds, such as beta blockers, can also increase blood sugar levels.
Also take a look at what kind of fluids the patient has going through the IV. A lot of IVPBs such as antibiotics will be mixed with dextrose or the patient might have a whole 1000cc bag of dextrose infusing. Dextrose = sugar, so that raises blood glucose levels as well.

excellent post, may I also add in the word "pain". I know you said stress, which is good, but I've always been taught that pain can also get the sympathetic nervous system and blood sugars going just like stress.

turnforthenurse, MSN, NP · Jan 27, 2011

excellent post, may I also add in the word "pain". I know you said stress, which is good, but I've always been taught that pain can also get the sympathetic nervous system and blood sugars going just like stress.

yes, that's true! thanks for adding :)