Still conscious with a BS of 24 ???

Long Term Care Columnist / Guide · Nov 9, 2003

I've seen quite a number of brittle diabetics who were virtually asymptomatic whether their FSBS was 30 or 700. That, of course, is NOT a good sign......often means their DM has been so poorly controlled that the body doesn't recognize when it's in serious trouble, and fails to produce symptoms that would call attention to the problem. Scary. I'm a reactive hypoglycemic who knows instantly when my sugar drops below 80, and when it goes above 150 I feel thirsty and headachy.........can't imagine having a FSBS outside those parameters and not knowing it!

jnette, ASN, EMT-I · Nov 9, 2003

Well, now... she DID feel it coming on... and that's when they checked it. She WAS symptomatic... cool, clammy, and becoming quite drowsy. Yet alert enough to know what was going on and be able to drink the OJ and sugar. As soon as the dextrose hit the blood, you could see her come around... instant difference.

For a relaticvely young woman, her kidneys must be those of an 80 year old. Sad.

Elenaster · Nov 9, 2003

Sounds pretty brittle to me Jnette! She would have gotten a stat BMP and and an amp of D50 in my unit, but then again, I'm an ICU nurse.

Our hospital is actually talking about putting everyone that is Dx as diabetic or has sustained hyperglycemia on an insulin gtt (for ICU patients). Theoretically, it's supposed to provide better glycemic control, but we've already had it backfire on a patient. He was a diet controlled Type II and within 3 hours of being on the inuslin gtt, we had managed to bottom him out with no more than 2 units an hour.

We also give tons of Decadron and Solu-medrol, which cause marked elevations in blood glucose, however most people return to normal after the steroids are discontinued.

I think we're likely to do more harm than good, and it's certainly a pain for the nurses. Q1h blood sugars on an otherwise stable patient is cruel if they're with it and don't have an a-line. Even if they do, it's sure to make your a-line crap out a whole lot sooner.

I'd prefer to stick with the sliding scale protocol we have in place right now, q6h blood sugars with regular insulin coverage if 200 or greater.

nocngail · Nov 9, 2003

I too had a lady that would sometimes make ya wonder as you were dashing off to find another glucometer. Sure enough, sugar was 36. She did admit to feeling "a little woozy". Geez... This lady was an elderly brittle diabetic who had "been on the same dose" of insulin with coverage for way to long. The milk/cracker thing definitely packs more punch than rebounding those unfortunate pts. with OJ....ah, the things us over-the-hill nurses didn't learn in school!!

With persistence from nsg. staff, MD finally changed the lady's insulin to a different type, and life was far less stressful..despite her poor kidney function.

SharonH, RN · Nov 9, 2003

Hey, it happens. You would be surprised at how many people do have those life-threatening blood sugars either way and are just chugging along. On my floor, that would have required a stat venous glucose along with an amp of D50 and probably an hourly BS until stable. When they are that low, I don't give a crud about the rebound I'll give them the juice and sugar. Now I won't do it for anything over 50 but I've seen nurses do it for a blood sugar as high as 100. A lot of nurses are uncomfortable with a blood sugar less than 150. We used to take care of a lady who did this routinely, so I was very careful to make sure she ate but sometimes it didn't matter. It was very frustrating.

flowerchild · Nov 10, 2003

I had a kid with a BS of 17 one time in the clinic. He was awake and alert. I called EMS and they arrived while I was shoving glucotabs into his mouth and praying. EMS stood in the doorway and said, "this isn't an emergency, looks like you have it all under control, pretend we were not here." I was fit to be tied! Luckily, the kid did fine and recovered quickly. I did report the incident to the director of EMS who just happens to be a friend of mine. This was not the first time EMS had let me down.

nursedawn67, LPN · Nov 10, 2003

When low enough I prefer the OJ and sugar to get them up to a safe level and then milk and crackers to maintain it. And if they are really low and won't really take the juice, I try ensure (just a bit), it never fails to boost them up to a more safe number. But you know to follow your facilities protocol.

**canoehead, BSN, RN** · Nov 10, 2003

I was driving into work not feeling well on evening, and hadn't had anything to eat when I got up. I took my sugar at work just out of curiousity and it read 27. I'm not a diabetic- just hit a low patch I guess. When I ate I almost immediately felt better and my head cleared. I hadn't even noticed that I wasn't thinking well until I felt my sugar go up. Scary. So now I keep cheese and crackers in the glove compartment, and usually drive with a bottle of Pepsi nearby. Never got a reading even close to that since.

Rustyhammer · Nov 10, 2003

Arent IDDM's fun?

Especially when they don't say anything and you find them unresponsive with a bottomed out fingerstick.

-R

obeyacts2 · Nov 10, 2003

The lady I care for has these dramatic swings too.....300+ at bedtime, 30 in the morning. We have a protocol of OJ/sugar waiit 30 min retest, insulin as indicated by sliding scale, then her meal. At 30, she has been up a/o x 3 and visiting with staff. We do insulin/ accuchecks q 4 hrs in the day, and a quick accucheck at 3 am, with OJ if she is under 100. She has had fewer lows since the MD adjusted her night dose (Lantus) she is on more than one form of insulin.

Laura

kids · Nov 10, 2003

Originally posted by canoehead
I was driving into work not feeling well on evening, and hadn't had anything to eat when I got up. I took my sugar at work just out of curiousity and it read 27. I'm not a diabetic- just hit a low patch I guess. When I ate I almost immediately felt better and my head cleared. I hadn't even noticed that I wasn't thinking well until I felt my sugar go up. Scary. So now I keep cheese and crackers in the glove compartment, and usually drive with a bottle of Pepsi nearby. Never got a reading even close to that since.

I have always been a meal skipper I rarely eat anything besides coffee before 1800 (even now). I was working 12 hour shifts on a sub acute unit, I had been working this same shift on this same unit for 2 years. Suddenly I started having problems with the 1600 med pass...everything seemed to go wrong, I was constantly behind, I was cranky because everyone was stupid, it was too hot (summer). One day after during a particully bad hissy fit my supervisor (OK, she was also my mom) made me check my blood sugar. It was 23. Happened again the next day...26. The following day I ate lunch at 1200, at 1630 I was 21. Basiclly, I had been walking, talking and PASSING MEDS with a bottomed out CBG. I had normal labs and glucose tollerence tests, I eventually figured out I needed to eat lunch at 1500, but only in the summer.