They act weird when their blood sugar is out of balance

[Alnitak7]

My first nurse teacher in high school told us about diabetic patients who act strange when their blood sugar is too high or too low. With no experience I could not be sure what she meant.

I was also taught about the ones whose blood sugar is too low who get belligerent.

I remember a patient who was very pale and was screaming and cursing so it was scary. I gave him a glass of juice which he quietly started drinking. He quieted down.

I have observed what looked like psychotic and childish behavior in people that I knew were diabetics and when their medications and patient care were not my business.

I have never known what to do. I did not know if it really was their diabetes or if they had some other thing wrong with them. I also never knew how to intervene unless they down on the floor.

I also know someone whose sugar runs high all the time and he shows no visible signs of it. He said his body is used to it.

[ktwlpn, LPN]

Why wouldn't you do a fingerstick if a resident is acting out of character? If the FS is within normal limits you would procede with a complete assessment (I hope) You certainly shouldn't wait until your diabetic patient is "down on the floor" .I've seen several adult onset IDDM's discovered by astute floor nurses.

[classicdame, MSN, EdD]

I have had hypoglycemia and can tell you I felt like I was dying. People who are dying act out, if they have the strength.

Whenever someone has a change in personality, whether diabetic or not, check the BS. It is a quick way to rule out hypoglycemia and can lead to rapid response and positive outcome. In the ER they would do a BS check and blood work for toxins/drugs.

[Alnitak7]

Just so you know, that patient I gave the juice to was on a floor where I was working as a C.N.A.

It was a number of years ago. In a lot of places I've worked the C.N.A.s are not expected to take blood glucose levels.

The charge nurse was sitting right there watching me.

I'm sure she did what she was supposed to with this patient but I had a number of tasks that I had to be on top of all at once

so I went on about my business.

[Alnitak7]

When I'm on my job I don't wait until someone is down of the floor to intervene.

When I'm out in public then there is a boundary issue that doesn't exist on the job. When you're out and around you can only call an ambulance for them if they give you consent unless they go unconscious.

My concern was more about the times out in public and not so much when I'm on the job.

[ktwlpn, LPN]

"My concern was more about the times out in public and not so much when I'm on the job" QUOTE.>>>> I didn't get that from your initial post-it's a little hard to understand. If you are out shopping and someone collapses it's really not too different from being on the job-Remember your A-B-C's ,call 911,look for a medical alert bracelet or card. You aren't going to have a glucometer handy so there is not much you can do unless they are carrying a fast from of glucose and have a medalert bracelet on them and you clearly identify a hypoglycemic reaction. If someone falls out in front of you in your local grocery store it could be caused by 1 of a hundred things-that's what EMS if for.

[Alnitak7]

I was not talking about when someone actually collapses. In cases like this, I do what my training tells me to.

[psu_213, BSN, RN]

When I'm out in public then there is a boundary issue that doesn't exist on the job. When you're out and around you can only call an ambulance for them if they give you consent unless they go unconscious.

That is really not true. Suppose you are at the grocery store. The clerk there is talking to you when his speech suddenly becomes slurred and he developed a facial droop. Call 911 right then. If his symptoms suddenly improve and he refuses EMS tx/transport, then that is between him and the EMS crew, but still call 911.

[psu_213, BSN, RN]

In cases like this, I do what my training tells me to.

Out of curiosity, what do you mean by this?

[ktwlpn, LPN]

QUOTE>>>>I have never known what to do. I did not know if it really was their diabetes or if they had some other thing wrong with them. I also never knew how to intervene unless they down on the floor.

[CDEWannaBe]

The brain works on glucose, so a low blood sugar often inhibits coherent thought. It's like dealing with a drunk.

In a public situation, if the person or his companions say he has diabetes the rule of thumb is always to give some sort of sugar (candy, soda, juice) then call 911. The sugar will quickly treat hypoglycemia. It won't have a real negative effect if someone has a high blood sugar, just makes them more hyperglycemic.

High blood sugars make a person feel lousy (pale, low energy, dehydrated) but hyperglycemia does not usually causes crazy behavior. If untreated it leads to ketoacidosis and a coma.

People with badly managed diabetes can often adjust to having chronically high blood sugars. So they feel fine at high levels and even exhibit hypoglycemic symptoms when their blood sugar gets lower than their typical set point. But even if a person feels find with high blood sugars they cause serious harm to the body. All the tiny blood vessels of the eyes, feet, and internal organs are affected, as well as the kidneys which are removing all the excess glucose out of the blood.

[Alnitak7]

I was referring to the times when I'm not at work and when I'm not carrying a finger stick. I do thank you for the advice. I'm hypoglycemic too.