Hyperglycemic Episode Treated w/OJ?

CHATSDALE · Jul 29, 2008

i would never give a unresponsive patient something that they need to swallow..this is a sure way to aspiration, there are gels which can be give sublingual

oj will not help a hyperglycemic persona nd you should learn to recognize different sx for different conditions

i agree with other posters that this is a stupid question

kmoonshine, RN · Jul 29, 2008

I don't know why you would give glucose to a patient with hyperglycemia. Only thing that would make "a little" sense to me is if the hyperglycemia was due to the somogyi effect. But at that point, they are already hyperglycemic and the treatment is modifying PM insulin to prevent nighttime hypoglycemia.

On a side note-

Here's why K+ is elevated with DKA (I'm such a dork):

Info on diabetes: Since insulin is needed to allow glucose to cross into muscle cells, an absence of insulin would lead to an increase in blood glucose (since cells cannot uptake the glucose).

insulin + glucose ---> muscle cells

When the muscle cells sense they are "starving", the horomone glucagon is released which causes the body to break down fat stores. This creates ketones, which can be considered acidic.

increased ketones ---> decreased pH

So here's where things get tricky: it involves the body's acid-base buffer system, which involves H+ ions (hydrogen ions = acid), K+ (potassium), and CO2 (carbon dioxide = acid). Here's the basic rules:

H+ can trade places with K+
K+ is mainly inside of cells (intracellular)
K+ crosses cell membranes whenever insulin is present

With DKA, patients are creating acidic ketones which decreases the body's pH. We can think of these ketones as H+ (acid); basically, H+ is in excess outside of the cell with DKA. And since H+ can trade places with K+, these H+ ions "trade places" with K+ inside of cells (this is the body's attempt to maintain normal pH). As H+ goes into cells, K+ comes out = hyperkalemia. Since insulin isn't present, K+ cannot go back into the cell.

H+ into cell = K+ out of cell

Also, since the body's pH is becoming acidic with DKA, the body also tries to get rid of excess acid by breathing off CO2. So, in this situation, the patient increases their respirations in attempts to "blow off" CO2 and stabalize the body's pH.

increased respirations ----> decreased CO2

The whole reason why I explained this is because it explains many of the clinical manifestations of a DKA patient, such as: increased respiratory rate (kusmal's respirations), cardiac dysrhythmias (from hyperkalemia).

So, with DKA regular insulin is given IV. As stated above, insulin and K+ cross into muscle cells together. As insulin takes glucose into cells, K+ comes along also = hypokalemia. Therefore, it is necessary to replace K+ while infusing insulin to prevent hypokalemia.

insulin + glucose + potassium ---> inside cell

Tip: if you have a DKA patient, make sure they are on a cardiac monitor; they are prone to cardiac dysrhythmias.

cardiacRN2006, ADN, RN · Jul 29, 2008

I don't know why you would give glucose to a patient with hyperglycemia.

You wouldn't!

The original question was about diabetic pts with UNKNOWN blood sugars being treated with oj/sugar/glucose, etc.

Hence, we don't know the pt is hyperglycemic, and we are unable to immediately test for FSBG.

In that situation (pt with diabetic emergency, no means to test FSBG) you always treat with sugar.

Faeriewand, ASN, RN · Jul 29, 2008

Another indicator,which is not always present,especially in type 2's is that hyper.patients are generally dry and hypo patients generally sweat.

We learned:

Cold and clammy, need some candy

Warm and dry, sugar high. :)

kmoonshine, RN · Jul 29, 2008

You wouldn't!
The original question was about diabetic pts with UNKNOWN blood sugars being treated with oj/sugar/glucose, etc.
Hence, we don't know the pt is hyperglycemic, and we are unable to immediately test for FSBG.
In that situation (pt with diabetic emergency, no means to test FSBG) you always treat with sugar.

Sorry for the confusion; the thread's title was "hyperglycemic episode treated w/OJ?" I was answering that part.

MassED, BSN, RN · Jul 29, 2008

QUESTION:
I'm not sure where I heard this but I was told that if you suspect someone of having a diabetic episode that you are supposed to give him/her sugar no matter what. My question is: Wouldn't that make the condition worse if they were having a hyperglycemic episode vs. a hypo? And if not, why? If the blood glucose levels are too high, wouldn't more glucose (in the form of broken down fructose) increase the chances of diabetic shock?

have never given OJ for high - this might be for out of a facility, on the street, since the s/s can be the same (confusion, lethargy)- to give sugar no matter what.