Pt with bs low on two different occasions overnight

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So on the second occasion I gave my pt a small slice of cake that we have stored in out fridge from the kitchen. The 1st reading was 48 I gave 2 glasses of oj and it went to 110. Then later it was 48 I gave a piece of cake and it went up later to 331 the dr was soo ****** he yelled to the charge nurse saying why would anyone give a diabetic pt cake. Was that so wrong???

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So what's everyones hypoglycemic protocols. My pt throughout the night had 2 low bs reading the first 48 and the 2nd 43 I gave oj for the first event then I was just like screw it give the lady some choc cake which we store in the fridge. Apparently that was not the correct thing to do because her sugar hours later spiked to 331. Later that day the doc found out and was infuriated yelling to the charge nurse about what kind of nurses he has and to never give a diabetic cake. I'm so confused if the patient is hypoglycemic whats wrong with giving cake??

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What is you facilities protocol?

Our protocol at my facility is as follows: if blood sugar below 60 and resident able to take by mouth give 15gm Glutose Gel, recheck blood sugar in 15 mins and call doctor. If blood sugar is below 60 and resident unable to take anything by mouth then give IM Glucagon as ordered, recheck in 15 mins, call doctor.

If the blood sugar is above 60 but on the low side for the resident then we give orange juice or milk. Some nurses will mix a packet of sugar in the juice or milk.

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Cake is not a good option.

By giving all that stuff you are going to overload him with sugar.

Try a snack with protein and carbs, such as a nutritional supplement or crackers with peanut butter.

A little may go a long way.

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Specializes in Trauma Surgical ICU.

Cake was not a good choice. Follow your facilities protocol to correct low levels. Also if this is a trend for the pt, maybe its time to look at how much insulin the pt is getting. Are they getting a snack at bedtime??

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Specializes in Med-Surg.

Why are you giving cake??

Maybe they are getting too much HS insulin and not recieving their snack or eating their supper.

Pass it on to the day shift to alert the physician so they can look at/alter the medications given (assuming this patient recieves sliding scale insulin).

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OJ is good, but something with more protein and fiber to follow up with will allow for a more controlled increase versus the peaks and valleys of fast-acting carbs (similar to how a child has a sugar rush and crashes).

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It probably was overkill. I know we had a discussion about how you no longer give patients OJ with sugar mixed in like they used to because it could jump too high. You just give them OJ and monitor them closely. If it doesn't go up, consider giving another OJ.

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Cake has way too much sugar!!!

I don't mean to be cruel but did you not learn appropriate snacks for hypoglycemia in nursing school? I'm glad you are asking this question but it shouldn't have needed to be asked.

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Specializes in Cardiac Care.
Cake has way too much sugar!!!

Oh come on lol. Getting on my soap box!

6 oz of orange juice has 20 grams of carb. Depending on the size of the cake of course, it can be quite comparable. 2 oz of chocolate cake has around 30 carbs. No idea what kind of slice was given to the resident though, it could have been significant.

And then you get into the issue of cake having fat content which will initially slow down the glycemic response, then prolong it.

Diabetes is all about balancing carbohydrate intake, NOT about being "sugar-free". That's a waste of effort if carbs aren't controlled.

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Oh come on lol. Getting on my soap box!

6 oz of orange juice has 20 grams of carb. Depending on the size of the cake of course, it can be quite comparable. 2 oz of chocolate cake has around 30 carbs. No idea what kind of slice was given to the resident though, it could have been significant.

And then you get into the issue of cake having fat content which will initially slow down the glycemic response, then prolong it.

Diabetes is all about balancing carbohydrate intake, NOT about being "sugar-free". That's a waste of effort if carbs aren't controlled.

I understand. But did OP not learn what snacks are appropriate to raise blood sugar?

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Specializes in Emergency & Trauma/Adult ICU.

"Screw it ... give cake" to get the blood sugar reading up says to me that you're simply looking for a number and not thinking critically about the patient's underlying pathology. Was the patient later given sliding scale insulin on the basis of that 331 reading? Then you know you're really just chasing numbers and not doing anything meaningful for the patient. I totally understand the MD's concern.

Orange juice is very high in potassium and so has renal implications -- it has been eliminated from our hypoglycemia protocol.

OP -- what is your hypoglycemia protocol where you work, and what was your reason for not following it?

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