Oral glucose or D50?

[exitandleave]

Hey everyone.

Did a quick search but couldn't find any information regarding this.

I've been a medic for a year and been in EMS for 4 years.

I recently had a call for altered mental status. Find the pt to be AOx2, just slightly confused and a little slow to answer complex questions. Airway patent with adequate respiration. Slightly diaphoretic. No distress. During our assessment we find she's a known diabetic who may have missed dinner. BGL of 52.

Our protocol states that medics treat a BGL of less than 60. The protocol leaves it up to the discretion of the medic whether to treat with D50 or oral glucose. I suggested we give oral glucose. My supervisor advised me this was a mistake because oral glucose takes too long to be absorbed and become effective, especially since we have D50 readily available.

Would you have treated this patient with oral glucose or D50? I'm not a lazy medic who would rather not have to go through the hassle of establishing an IV, replacing a drug box, etc. But I don't find it necessary to be over zealous in treating a stable patient like this.

Also, does anyone have any information from personal experience or reading as to how quickly oral glucose is absorbed? I know d50 is quicker, but I recall a similar situation where I gave two tubes of oral glucose and signed the patient of 15 minutes later.

Thanks for your input/advise/criticism.

 

[Shishkabob]

Able to consciously swallow without any foreseeable complication? Oral glucose. Unable to consciously control their airway? IV or IM meds.

I personally don't like starting an IV to give a medication if I can give a medication via another route for the same desired effect (Hello Zofran, hello Versed)... especially if it's likely that the patient is going to refuse going.




Oral glucose DOES take longer than D50, on the order of minutes, but in my experience it's faster than IM Glucagon.

 

[Handsome Robb]

Able to consciously swallow without any foreseeable complication? Oral glucose. Unable to consciously control their airway? IV or IM meds.

I personally don't like starting an IV to give a medication if I can give a medication via another route for the same desired effect (Hello Zofran, hello Versed)... especially if it's likely that the patient is going to refuse going.




Oral glucose DOES take longer than D50, on the order of minutes, but in my experience it's faster than IM Glucagon.

My thoughts exactly.

 

[mycrofft]

Not to get between you and your boss, but oral sounds OK.

But keep watching the glucometer, if it got lower than 40 ten minutes after the oral, I'd go IV. The seizure threshold for a common person is about 20's but some folks will go sooner (especially if they have seizure disorder).AND, once that oral is on board, sandwich and a beverage.

 

[MSDeltaFlt]

A&O X 2 with BGL=52. Technically symptomatic. But sugar is not that low. Only 8 points. 6 to one. Half a dozen the other. Your choice.

 

[Shishkabob]

A&O X 2 with BGL=52. Technically symptomatic. But sugar is not that low. Only 8 points. 6 to one. Half a dozen the other. Your choice.

My protocols at my new agency have the adult range of 80 instead of the usual 60 for adults, meaning a 28 point difference, within the "30 point error range" of some glucometers. His agency might be the same.

 

[shockinainteasy75]

Agreed, if pt. is oriented enough to understand your directions with the oral glucose, id go with that. In the mean time you could set up with the IV supplies and get your D-50 out in case the oral glucose dosent see improvement. Id also have the pt eat a sandwich, peanut butter crackers etc or drink some milk or orange juice.

 

[Smoke14]

Why didn't you fix the patient a meal and monitor the BGS levels?

 

[MSDeltaFlt]

My protocols at my new agency have the adult range of 80 instead of the usual 60 for adults, meaning a 28 point difference, within the "30 point error range" of some glucometers. His agency might be the same.

He said that his protocols leaves the choice of either/or at the medic's discretion. Which is why I told him it was even money.

 

[NomadicMedic]

I would've gave her a big glass of orange juice, and then made her sandwich. OJ is a lot more palatable than oral glucose.

 

[bigbaldguy]

I would think that going for the less invasive method of delivery would always be preferable assuming that the patient is relatively stable. On the other hand if you start an IV it means more money they can bill for :/

 

[Handsome Robb]

On the other hand if you start an IV it means more money they can bill for :/

Depends on your service. Here we have an ILS/BLS rate and an ALS rate both have mileage added on to them. If we treat and release the patient isn't charged, we don't charge for the individual treatments during the transport.

 

[Shishkabob]

He said that his protocols leaves the choice of either/or at the medic's discretion. Which is why I told him it was even money.

Ah, I thought you were commenting on just 8 points below 60 for a bgl. My bad.

 

[exitandleave]

Thanks for all the replies guys.

We don't charge for refusals here. And with any diabetic refusal we always make sure they got a meal prepared before leaving so that wasn't going to be an issue.

Just providing OJ and a meal instead of glucose would have definitely been an option also.

Thanks again.

 

[ksmith3604]

Im with the people who said OJ and a sammy. I like to think outside of the box when it comes to treatments like that. If you can accomplish the same desired effect of a BGL above 60, and AAOx4, without giving a med....why give the med.

 

[mycrofft]

I've seen people with s/s and fingerstick glucometry of 70.

Tremors, hunger, diaphoresis.

 

[NineLine]

I've been in this exact situation before. We responded to an "unknown medical" call at the local county jail. We walked in and met the guards who said the pt. was acting violent and not responding to verbal commands while in the clinic for morning insulin. We entered the clinic and asked the clinic staff if they were able to get a glucose reading. They weren't able to because of the pt's violent behavior. I got a d-stick with bgl of 48. Pt had a patent airway so we began with oral glucose, 5 minutes later pt's bgl was 63. We gave 2 more doses and reassessed the pt at A&OX4 with bgl of 98. He refused transport and that was that.

In our situation to gain IV access we would have had to get several guards to restrain the pt and risk a possible needle stick while obtaining access. We decided to go with the simplest treatment and if that didn't work we would go with the IV. Luckily, oral glucose did the trick.

 

[phildo]

I've had patients with BGL of 52 who were GCS 3. I have functioned with a BGL of 27.(felt a little light-headed, checked it after dropping off my patient) If they are able to talk and obey commands, give it orally, then watch them eat a pb&j and drink milk or OJ.

 

[Shishkabob]

We entered the clinic and asked the clinic staff if they were able to get a glucose reading. They weren't able to because of the pt's violent behavior.

If it's the facility I'm thinking of, don't EVER trust them to do anything medical, or do anything medical correctly. Just.. don't trust them.

 

[NineLine]

If it's the facility I'm thinking of, don't EVER trust them to do anything medical, or do anything medical correctly. Just.. don't trust them.

LOL! No that was back when I worked in Austin, but I've also had dealings with the county jail here and I know what you mean...