Low blood sugar, juice or D50?

BluegrassRN · Apr 17, 2010

I would have done the same as you. It's easier to do the D50, from the nurse's perspective. You know your patient is getting it, you don't have to trust your patient to drink or eat. Maybe it's a control thing with your fellow nurse.

I think it is terribly rude and presumptive, though, to override a type I diabetic's decision about what to use to bring up their blood sugar. Like you said, they know their body best, and they know what works best. I work with several type ones, and one of my closest friends is a type one diabetic. If they were low, were dealing with it appropriately and how they wanted to deal with it, and a nurse came in trying to give them D50 despite their wishes, that nurse is going to end up with D50 shoved where the sun don't shine.

The only thing I would have done differently in your case would be to recheck her blood sugar, so that you could have definitively reported where she was. And even then, that depends upon the time frame. Next time, check your protocol, as you sounded unsure of what exactly it is. Our is to give juice, graham crackers and peanut butter, or the equivalent if the pt is alert and able to swallow, or to give D50 if the patient is not alert or able to swallow. Blood sugar is to be rechecked every 15 minutes until above 70.

mappers · Apr 17, 2010

Her BS was going to be rechecked. It just wasn't in the timeframe yet. That's why I went to tell the other nurse what I'd done, so she could re-check her in a few minutes.

I wasn't unsure of what to do until the other nurse said, "I'll get D50". Everything I've seen regarding the protocol is to give juice, etc if they can eat, which is why it really surprised me when she said that. Even the other nurse with her said, "Aren't we just supposed to give them juice if they can eat?" (She isn't the most confident nurse, so her statement didn't necessarily re-assure me.)

This was one of those, the more I thought about it after I got home moments.

And I'm not really sure how this particular patient would have reacted if the nurse had come in with D50. She seems to LOVE being a patient, IYKWIM. Nothing "normal" works for her, in her opinion. She was very happily chronically ill, with all kinds of weird reactions to meds, etc. She might have loved the interevention of using something IV...LOL....Or she might have reacted like you said.

mappers · Apr 17, 2010

PS....are you in KY (Bluegrass and all)? If so, me too!

oramar · Apr 17, 2010

If your protocols allow for handling the situation that way fine. However, perhaps that other nurse worked at places that had doctors that have their own protocols that specify D50 for a 39. I know some endocrinologist that would be furious if you didn't follow their protocols. I actually had my fellow nurses raise an eyebrow when I was following hospital protocol and nudge my memory by saying "ah, that is a doctor SMITH patient". I was glad they did because Dr. Smith was a real bear when someone followed the hospital protocol instead of his. Confusing yes, but we got used to it after a while.

supernatural · Apr 17, 2010

We give an amp of D50 then call the MD it is protocol at our hosp. People can go into a coma a die at that low of a BS. Plus most people end up dieing with sugar that low. An amp of D50 should have been first. Then a page to the MD with a recheck on the BS. If that patient went into a coma or died you could have been held medically liable for your actions. :eek:

DuluthMike · Apr 17, 2010

If the patient can tolorate juice, go with that. There is no reason to administer D50. D50 is not benign.

mommyX2 · Apr 17, 2010

At the hospitals I have worked at the general rule was that if the patient was alert, you give food or maybe a glucose tab. D50 was for non-responsive pts or pts too far out to eat.

southern rn · Apr 17, 2010

We give an amp of D50 then call the MD it is protocol at our hosp. People can go into a coma a die at that low of a BS. Plus most people end up dieing with sugar that low. An amp of D50 should have been first. Then a page to the MD with a recheck on the BS. If that patient went into a coma or died you could have been held medically liable for your actions.

I'm sorry I will have to disagree with you on this. I have seen MANY,MANY patients over the years with blood sugars this low and lower.It is certainly low enough to cause lethargy but not coma, and to say that most people end up dying from a blood sugar of 39 is simply not something I have seen. OP, If in doubt check your protocols or the patients orders on how to treat;in the scenario you just describe dI would have done exactly the same thing you did. If she didn't respond to food or got more symptomatic then certainly go ahead with the d50.

leslie :-D · Apr 17, 2010

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.

leslie

paranrs66 · Apr 17, 2010

I think you did fine! If you had decided to give D-50 that would have been fine too! There are pro's and con's to each decision. For ex. You know you had to be prepared to manage an airway if the pt. had gotten into trouble swallowing while her sugar was so low. Sometimes people with tolerate low sugars well, another time they will not. If you had given D-50 there are risks there as well, extravasation, rebound, etc. It's easy to second guess someone, but only the person making a decision saw, felt, smelled and heard the whole picture and you are the one who has to take responsibility for doing something as well as doing nothing! I know you know this! Good job following thru, too! Another nurse may have just given report and left, another may have given D-50 and reported then left, b/c they would have gotten off on time since D-50 is generally faster to bring up B.S. than watching someone eat and waiting for BS to begin to rise slowly with digestion. Good Job on doing the "right thing" for your patient! :) Just my two cents...

Penelope_Pitstop, BSN, RN · Apr 17, 2010

Plus most people end up dieing with sugar that low.

I respectfully disagree.

Perhaps most people die with a glucose of 39 without interventions. However, giving juice to a patient constitutes an intervention. This patient most likely had sugars this low at home before, and most likely didn't have an amp of D50 at hand. She clearly knew how to take care of her hypoglycemic episodes appropriately. If, in fifteen minutes, the juice didn't bring up the sugar, or, worse, the sugar dropped, (I've seen it happen and it's crazy!) that's when I would have considered D50 or glucagon.

Otherwise, I only give D50 if there is a specific order for it (this is rare), if the patient is NPO, or if the patient is unable to drink juice safely.

My guess is that this patient was more in danger of death due to poor control of diabetes than for one particular blood sugar in the 30's.