Hypoglycemic Symptoms But Still Elevated Glucose

Nurses General Nursing

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How do you treat a patient who is experiencing hypoglycemic signs and symptoms, yet their glucose reading is higher...like 150mg/dL? I had a conversation with a friend who told me that individuals who normally have elevated glucose levels, say like 250, and it drops, due to not eating, and they may experience the same sort of symptoms, because this is low for them compared to their average. Do you still give them orange juice, to at least help them feel better or is there another intervention? Just curious...

Thanks!:heartbeat

Who adds sugar to O.J? :eek::eek::eek:

I have, when the BG drop was fast and severe and I was concerned that the pt wouldn't be able to get more than a few sips in. Per protocol where I worked.

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I have, when the BG drop was fast and severe and I was concerned that the pt wouldn't be able to get more than a few sips in. Per protocol where I worked.

If the patient is unable to swallow or is unconcious and you don't have IV access you can go the rectal route with any liquid containing glucose.

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If the patient is unable to swallow or is unconcious and you don't have IV access you can go the rectal route with any liquid containing glucose.

Probably. But OJ and sugar were available.

:)

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Specializes in icu, er, transplant, case management, ps.

I am a Type 2 and on NPH and metformin. When my blood sugar drops, which it does rarely, I have advised my roommate to call 911 and make sure I continue to breath. I want no one but a paramedic attempting to elevate my blood sugar. But there are Type 2's who have been running high blood sugars for some time and suddenly drop to 140 or 150, exhibiting symptoms of hypoglycemia. On the ADA boards, we do not advise anyone in the field to do anything but call 911. Or if the person is alert to do what he/she needs to do to elevate their bs if the are truly hypoglycemic, 50 or under.

False hypoglycemics are advised to continue in their attempts to lower their blood suagrs until they get them down to an acceptable range. If the person is truly awake and able to give correct answers to questions, give a liquid, no more then four ounces, that has a high carbohdrate content, such as OJ, apple or even regular pepsi or coke (4 oz or less). Check their blood sugar in fifteen minutes but call 911 anyway. If they are an in-patient, notifiy their physician. This is what my Certified Diabetic Educator told me, when out in the world. The in-patient routine is normal routine in most hospitals. And it includes checking the person's blood sugar and not giving anything until it is truly hypo.

Woody:twocents:

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Specializes in Community Health, Med-Surg, Home Health.
I am a Type 2 and on NPH and metformin. When my blood sugar drops, which it does rarely, I have advised my roommate to call 911 and make sure I continue to breath. I want no one but a paramedic attempting to elevate my blood sugar. But there are Type 2's who have been running high blood sugars for some time and suddenly drop to 140 or 150, exhibiting symptoms of hypoglycemia. On the ADA boards, we do not advise anyone in the field to do anything but call 911. Or if the person is alert to do what he/she needs to do to elevate their bs if the are truly hypoglycemic, 50 or under.

False hypoglycemics are advised to continue in their attempts to lower their blood suagrs until they get them down to an acceptable range. If the person is truly awake and able to give correct answers to questions, give a liquid, no more then four ounces, that has a high carbohdrate content, such as OJ, apple or even regular pepsi or coke (4 oz or less). Check their blood sugar in fifteen minutes but call 911 anyway. If they are an in-patient, notifiy their physician. This is what my Certified Diabetic Educator told me, when out in the world. The in-patient routine is normal routine in most hospitals. And it includes checking the person's blood sugar and not giving anything until it is truly hypo.

Woody:twocents:

First, thanks for sharing your experience. I need a bit of clarity; when you say that false hypoglycemics are advised to continue focusing on lowering their glucose levels, but are experiencing hypoglycemic symptoms, are you saying to give them 4 ounces of a high carborhydrate beverage to relieve their symptoms? Thanks...just trying to see if I get what you are saying.

It's funny that I decided to ask this question, because we had a patient come into the clinic this way yesterday afternoon (a premonition of mine, maybe?). She felt cold and clammy, lightheaded and a bit shaky. Blood sugar was 194, she said she is usually about 250mg/dl. At the time, I took her to the RN, and had to continue with my Coumadin patients, but was curious to know how she would have been treated. Ultimately, I heard later that she was sent to the ER, but I didn't get a chance to speak to the triage RN to ask how the decision was made to send her there (just for my own knowledge, since I may one day be alone and experience this for myself).

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Specializes in icu, er, transplant, case management, ps.
First, thanks for sharing your experience. I need a bit of clarity; when you say that false hypoglycemics are advised to continue focusing on lowering their glucose levels, but are experiencing hypoglycemic symptoms, are you saying to give them 4 ounces of a high carborhydrate beverage to relieve their symptoms? Thanks...just trying to see if I get what you are saying.

It's funny that I decided to ask this question, because we had a patient come into the clinic this way yesterday afternoon (a premonition of mine, maybe?). She felt cold and clammy, lightheaded and a bit shaky. Blood sugar was 194, she said she is usually about 250mg/dl. At the time, I took her to the RN, and had to continue with my Coumadin patients, but was curious to know how she would have been treated. Ultimately, I heard later that she was sent to the ER, but I didn't get a chance to speak to the triage RN to ask how the decision was made to send her there (just for my own knowledge, since I may one day be alone and experience this for myself).

I realized after I had posted the confusion. Most of the posters, on the ADA board, advise the person who is experiencing false hypoglycemic attacks to initially treat their false hypoglycemia but to work at lowering their blood sugars. Despite what is usually advised, a lot of us, who have experienced false hypoglycemia attacks during the course of our disease, do not treat them unless they are truly below 50-60. I do not treat mine unless I have dropped into the 40's. I watch my blood sugar when it drops below 70 but I do not treat it, just retest in fifteen minutes. Generally it has gone up. The patient that was sent to the clinic was more then likely sent for a blood draw and possible treatment. While her symptoms could have been related to her Type 2, they could have several other causes, necessitating an evaluation in the ER..

When I am in the hospital, I am generally on steroids which cause my blood sugar to sky rocket. So, I am on a sliding scale. But I also try to follow the low carbohydrate diet that I eat at home, 70 to 85 grams a day. When I was in ICU, I was on an insulin drip because of the high dextrose IV that I had to be on. I have never experienced a true hypoglycemic attack in the hospital. My six have all been outside, at home and once behind the wheel. What you should do, is tell anyone who is on insulin to test their blood sugar just before they get behind the wheel. And if driving for more then a hour, they should pull over and test their blood sugar every two to three hours. This is what my PCP wants me to do and it has served me well. The recent long term drive-four days, I recent took, I ran a blood sugar of 140 behind the wheel. It was high for me but I felt safer. In town, my blood sugar is generally 90 to 108. These are lower then most Type 2's but I feel better at these blood sugars. And I have yet to develop any complications, after eighteen years.

The best thing that any nurse can do is to advise a new person to buy or check out of the library, any of the several books on diabetes. And keep a food diary. And set reasonable goals. It one's blood sugar is 300, don't set a goal of 110. You will suffer a false hypoglycemic attack and you will fail at your attempts eventually. Have them set a more reasonable goal of reducing the blood sugar by 50 every two to three weeks or months, whatever it takes. A few of the newbies are motivated to get their blood sugar under strict control right away. But most are not. And when they go to the doctors or see us, we all imply what a failure they are, when they don't meet our goals. Work with the patient. Help him set goals he can reasonably reach. Take into consideration his type of work, his culture, his family's likes and dislikes, his time, his commitment, the support he has or doesn't have.

I can tell you, from my own experience, a pat on the head, a handful of papers and a vague list of goals really didn't help me. I ignored my disease for all most two years. Fortunately I didn't suffer. And when I look back at the goals my PCP set for me, today he would consider me non-compliant. I eat 70 to 85 grams of carbohydrates a day, take 35u NPH and 500 mgs of metformin twice a day. I take walks twice a day and swim three times a week for one hour. But it takes real commitment on my part. And three or four times a year I fall off, up my NPH, sometimes take regular insulin and eat what the rest of my family does, Thanksgiving, Christmas, Easter on my birthday. He wants my fbs to be in the 70's and my posy meal two hour to be no more then 120 and my A1c to be 5.2. I have been a 5.2 for the past ten months:yeah:.

If I were working today, I would encourage the newbie to do what I have suggested. And tell a wife or husband to support, not scold. And if the spouse is non-supportive, look for outside support through groups. Exercise as you can. And don't think of yourself as a failure if you have to add a medication or two or go on insulin. They are tools mean to help you.

Woody:twocents:

Sorry for preaching

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