Low blood sugar, juice or D50?

[mappers]

Last night I had a patient with a BS of 39. I had just finished giving report on her when she asked us to check her BS. Since the oncoming nurse still had to get report on a few more patients, I got the aid to check the BS then did the following....

She was alert, oriented, walking, talking, etc. (She was diaphoretic and seeing black spots, but very capable of eating and drinking.) I got her OJ, crackers and peanut butter. She also had Glucerna at her bedside. She drank the OJ, insisted on drinking the Glucerna too. (Type I DM for 16 years. I often trust what they say since they've been managing their disease for a long time.) She said she'd eat the PB and crackers too. Said she was starting to feel better and I could tell she was "perking up".

I felt confident she was doing better, found the other nurse who had just finished report, and told her what I'd done. She said, "I'll get her an amp of D50."

So with a BS that low, what would you have done? I think our policy is to give food and juice if the patient was able to eat, not NPO, etc. There is no "low end" as far as I know to always give D50. Does it work faster? With a BS of 39, would you use D50 even if the person could eat?

This has been bugging me all night. I actually had a dream that they called an RR on her after I left. (Very odd-ball patient, probably undiagnosed bi-polar or personality disorder. She'd taken up A LOT of my time that day and had gotten under my skin, which is probably why she was so much on my mind.)

[luvpets]

What would you do if your patient was diaphoretic, unconscious, and blood sugar of 30? Would you first inject dextrose?

thanks

[ParvulusPuella]

If they were unconscious? Of course the D50.

[sbostonRN]

Unconsious: Medical Emergency and D50

Conscious and able to talk: I'd do as the original poster did. I've had a patient with a BS of 34 at my previous facility, was conscious and her only symptom was feeling weak and seeing black spots. Got her OJ spiked with sugar and stayed with her. However at my current facility, the protocol is to notify the MD with any BS less than 70. So if it was that low, I'd start the hypoglycemic protocol and have someone call the doctor at the same time.

[jadelpn, LPN, EMT-B]

If the patient is A&O juice is a fine intervention, with a bs check after. Keep a close eye on the patient and recheck the sugar-- with juice it can and does then go quite higher after some hours. Hence why you never want the patient to get into a cycle of treating low blood sugars day after day. It could be an indication that the patient's diabetic medication needs to be tuned. Always call the MD for blood sugars that low (after the intervention). I have never seen a person die from a low blood sugar. I have seen seizure activity, passing out, that type of thing. And that is not usually the best circumstance for a patient to go home and try to live an active life with, and they need to be able to manage their diabeties when they leave your care. I have seen people criticially ill from too high a blood sugar. In the longer term, it is of note that if you are getting lots of lows or lots of highs the MD needs to re-assess what the person is taking for medications and how much, as well as a re-assessment of sliding scale and long acting insulin doses if they are on this medication. As far as D50, it would depend on your protocol, and if the person is unable to eat or drink anything.Not to mention that there's IV dextrose, and oral dextrose. Oral dextrose is similar to giving juice. When someone is unable to swallow due to their blood sugar, then you get into IV stuff that needs an MD order. And OP become familiar with your protocol, or ring for assistance of your charge nurse. In your original post you mention that you "think" that such and so is protocol. If you don't know for certain, ask for assistance. And always be familiar with your protocol as the above poster stated--some facilities require a call to the MD for any sugar less than 70 every time--and have hypoglycemic protocols to follow. But ask for help.

[bjaeram]

The patient is a known diabetic so I can almost guarentee there were orders on the chart for this situation. Were they on sliding scale insulin? If so the scale also includes what to do for lows, at least at our hospital. If not specific patient orders the hospital would have a policy.

I would have done what you did. Just make sure they follow with breakfast or whatever meal to keep the sugar up. A quick sugar fix = a quick sugar drop when it wears off. Definitly give them some longer lasting carbs. That is a problem with a dose of D50 too! I wouldn't give IV sugar if you have an alternative...it's so hard on the veins!

[eatmysoxRN, ASN, RN]

So...

What if the patient were NPO for a test but the blood sugar was around 50? Or what if the person had a gtube? At 39, would you put o.j. through the tube or do the d50?

Our policy is juice (don't add sugar) and recheck in 30 minutes. If unable to eat/drink then do d50. Our policy doesn't go into the ifs....

[CountyRat]

In my experience, patients who have had diabetes for many years usually get very good at knowing when they need sugar, and when oral sugar is adequate. As for juice vs. D50, I always prefer the less invasive (in this case oral) option so long as it is reasonable and safe. I would have done as the OP did. However, I also agree with those who advocate rechecking the BS soon after treating hypoglycemia. In fact, any time we intervene in a potentially critical event, we should reassess, whether it is the scheduled time or not.

[uRNmyway, ASN, RN]

I think it depends on your institution. Check your policies and procedures manual. Where I have worked, doesn't matter how low the BS is, if the patient is responsive and able to eat, you feed them. Start with the sweetened juice, Glucerna, whatever it is. Then recheck your BS. Once it is stabilized, you offer some kind of proteinated snack, like cheese, milk, yogurt, etc. for longer term BS maintenance. If however at any point your patient becomes unresponsive, that is when you would push the D50. And I should mention, if the BS was below a certain level, the MD was to be informed ASAP. Then I guess you follow the MD orders.

But again, that is for where *I* worked. Check your P&P manual.

[uRNmyway, ASN, RN]

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.

Wait, WHAT?! I have seen several patients with BS in the 20's and they came right back up with snacks. None of them died. Most were still responsive. I have no clue where you got that information.

[nursemike, ASN, RN]

Got curious one night and read some labels. Amp of D50 and 4oz OJ are very similar amounts of carbs. Don't add sugar to the OJ, it's overkill. And D50 through a peripheral is nothing to be taken lightly. Pretty much everything we do carries risks, but an AO pt who is talking can probably drink some juice. A snack with some protein (PB and crackers, for example) will help stabilize blood glucose.

[nurseprnRN, BSN, RN]

Aw, nursemike, there you go spoiling perfectly good speculation-fest with actual, like, information. Well done.

:yelclap:

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[nursemike, ASN, RN]

Aw, nursemike, there you go spoiling perfectly good speculation-fest with actual, like, information. Well done.

:yelclap:

Note: to get full impact of this message, it should display in Comic Sans, green. Thank you.

Thank you. If I could just keep my own A1c in single digits, I'd feel like bragging. I recently treated a pt for "hypoglycemia" of 75 (wasn't dying, of course, but felt crappy) and I was pretty proud of myself when his overnight labs read a glucose of 133, then a.m. fingerstick was 120-something. It has taken awhile, but I'm learning not to drive tacks with a sledgehammer.