What the recovery time after a severe hypoglycemia

Twinmom06, ASN, APN · May 8, 2013

wow - 4 hours? Glucagon works on the liver - does she have any kind of liver impairment?

for me (but I'm 39) it usually only takes 15-30 minutes to get my sugar back over 100 - yes I'm diabetic...

dudette10, MSN, RN · May 8, 2013

It usually doesn't take long for blood sugar to go up. I did have a patient w/ a BS of 22, and it took about 30 minutes w/ two rounds of oral interventions to get it within normal range. Awake, alert, and getting visibly better during that 30 minutes. As a side note, it's probably time for the PCP of the resident to have a chat w/ the DPOA about what is and what is not easily treatable.

MunoRN, RN · May 8, 2013

The amount of time it takes a BG to get back to normal depends on the underlying cause. In a non-diabetic who is not receiving insulin, common causes include metabolic 'derangement' secondary to other syndromes, and pancreatic tumors. Both can cause inappropriate releases of insulin that can be of short duration or they can last hours.

It's not unusual for patients to plan on not going to the ER if they become acutely ill, it's the patient's right to make that choice. And so as long as the DPOA is accurately reflecting the patient's wishes then that should be honored.

akulahawkRN, ADN, RN, EMT-P · May 8, 2013

Four hours is a bit long for a response time with that. Oral mucosa is somewhat able to move some sugar over to the vasculature, but it's not that slow, usually. What may have happened is that the sugar placed in there may have actually dried the mucosa out, leading to an even slower rate of transfer. If there's no response to glucagon, that means that the body's glycogen stores are basically zero. There's nothing left for the glucagon to affect. I've given D50 IV quite a few times over the years before I got into nursing. I can tell you from watching the reactions to it, it doesn't take long for the "lights to turn on" if adequate sugar is being supplied and getting into the bloodstream. Usually right around 15-20 grams of Dextrose in is when that happens. Sugar sublingually works pretty good, but moisten it a little bit so it doesn't have to depend upon moisture provided by the salivary glands.

And the Physician needs to have a good chat with the DPHAC on this. Transfer out isn't necessarily warranted, but the ability to treat a low blood sugar a little more aggressively may be. Dextrose metabolizes pretty quickly so remember to have the patient eat something more substantial after they wake up.

turnforthenurse, MSN, NP · May 8, 2013

I agree, 4 hours is a little too long. Glucagon can work, but if the liver's glycogen stores are depleted, glucagon isn't working to work. Personally, I would have given D50 via IV STAT, but that's also in my hospital's hypoglycemic protocol.

pinkessence_58467 · May 8, 2013

Oops forgot a part, blood sugar did go up within an hour to 88 resident remained unresponsive but then dropped again

dandk1997RN, MSN, RN · May 12, 2013

Oops forgot a part, blood sugar did go up within an hour to 88 resident remained unresponsive but then dropped again

If the pt was unresponsive at 88, I would question either something else going on or the validity of the draw.

My last shift, I watched a situation unfold with a new grad/ preceptor combo and their pt who went low (40s) got an amp of D50, went high (200) got insulin (novolog and levemir, why oh why???) went down to 20ish...another amp of D50 and a D5W gtt, then a D10W gtt...all this occurred over a course of a few hours. Her BS and LOC changed quickly when the D50 was pushed- maybe 15 minutes?