quick glucose question

[bravesfan160]

I had a patient the other day i was taking for a fall in her nursing home, all her vitals were wnl except when I took her sugar and wrote it down, she asked what it was. It was 94. She then says "oh no, that's really low. My sugar is usually around 170" she has no history of dm. The patient was alert and oriented, andwering all my questions before that so I believed her. I wasn't sure if to give glucose despite her sugar being wnl, or to give it because it's low for her norm. I ended up giving her oral glucose per standing orders and transporting.

I was wondering if that was the right call or not.

Thanks

 

[Shishkabob]

170 is high. 180 tends to start the osmotic diuresis seen with excessive hyperglycemia.


If they aren't symptomatic, why give glucose?

 

[bravesfan160]

I did it more to cover myself in the event that she started becoming symptomatic.

 

[Shishkabob]

Naw, with it that high I wouldn't have given anything to just cover myself.


Protocols vary, but mine state 110mg/dL for diabetics or 80mg/dL for non-diabetics AND "Patients who are disoriented, weak, dizzy, confused, suffered a syncopal episode or are unconscious"

 

[bravesfan160]

Ah. Thanks for the info.

 

[VentMedic]

Was was the rest of her history? Was she taking corticosteriods?

 

[EMTinNEPA]

If it ain't broke, don't mess with it.

And if she DOES become symptomatic, you can always give her the glucose then.

 

[DrParasite]

kind of a stupid question, but if she wasn't a diabetic, how does she know that her sugar is generally 170? i mean, even in a nursing home, I can't see them bleeding people's fingers just for fun

 

[VentMedic]

kind of a stupid question, but if she wasn't a diabetic, how does she know that her sugar is generally 170? i mean, even in a nursing home, I can't see them bleeding people's fingers just for fun

If she is on corticosteroids chronically, her BGL may be monitored. This will include patients with many different inflammatory diseases.

 

[skivail]

Did she have it confused with her BP?

 

[MS Medic]

The answer to your question would be to treat according to your protocols. Mine state to initiate treatment if the CBG is below 70. If the patient can follow commands and swallow give oral glucose otherwise we give 12.5 of D50 with a 15gtt run wide open to dilute it down to as close to a D10 or D5 state as possible. Then monitor the CBG and give the other 12.5 if needed.

 

[ghostrider]

if the pt bg is norm 170 and pt is currently @ 90 with no s/s of hypoglyc. I would not treat until presenting w/ s/s of hypoglyc. but would definatly watch carefully. additionally when performing bg check did you use capilary blood or venous blood from an iv. reson being most bg moniters are not calibrated for venous samples.

 

[Lifeguards For Life]

additionally when performing bg check did you use capilary blood or venous blood from an iv. reson being most bg moniters are not calibrated for venous samples.

why not? what is venous blood but return of the capillary blood?

while there is a slight difference about 0.33 mmol/l, between venous and capillary blood do you think your treatment will be effected? especially with the hand held glucometer?

If you get your BGL off the iv catheter and it reads high, you know the capillary blood is slightly higher. If the venous BGL reads low, the capillary blood would still be assumed to be slightly higher.

you are looking at a 5mg/dl difference at most, which is not going to change much.

 

[MS Medic]

additionally when performing bg check did you use capilary blood or venous blood from an iv. reson being most bg moniters are not calibrated for venous samples.

I've found the the venous reading "usually" runs about 20 to 30 points lower than if I get a cap reading. If I have an asymptomatic pt and the reading is in normal limits or high I will stick with the venous reading if the pt is altered or I am getting a treatable low reading, I will do a finger stick to get a cap reading.

 

[MrBrown]

If you get your BGL off the iv catheter and it reads high, you know the capillary blood is slightly higher. If the venous BGL reads low, the capillary blood would still be assumed to be slightly higher..

You really shouldn't be doing that, naughty naughty

 

[ghostrider]

yeah the info i have gotten from endos (my son is type 1) is that there can be up to a 30 point differance between the two. I'm not and endo though, so im going with a finger stick which is what the hand helds are calibrated for. the differance is irrevelant if you use the moniter per manufact. directions. I have personally seen 3 moniters of the same brand get 3 differant readings from the same site. bg sensors can be up to 30 min behind hand helds the variables go on and on. addit. if you use something like Lidocaine prilocaine cream 2.5%/2.5% prior to IV insertion the reading can be greatly affected.

 

[redcrossemt]

Have done the capillary v. venous BGL comparisons myself on a number of patients, and a coworker did it more in a more significant number of patients. There was a difference of more than 20 in every single patient. There is some research out there on the difference, and it has been mentioned previously.

To the OP, no, would not have treated unless the patient was symptomatic.

 

[EMS84]

4 to 8 is feeling great....where did you pull those numbers from??????

 

[Dominion]

The answer to your question would be to treat according to your protocols. Mine state to initiate treatment if the CBG is below 70. If the patient can follow commands and swallow give oral glucose otherwise we give 12.5 of D50 with a 15gtt run wide open to dilute it down to as close to a D10 or D5 state as possible. Then monitor the CBG and give the other 12.5 if needed.

If you're going to dilute it down to as close to D5 as possible, why not run a bolus of just D5? Or do you not have that on your trucks?

Additionally while your protocols are there to guide your treatment, you can use your own thought processes as well. I've had patients who BGL read 70, but they were alert, talking to me, answering appropriately, and just generally stable. Our protocols state < 75 administer Oral Glucose if able to swallow or IV D50 if unable to swallow. By my protocols standards I should have given them a tube of glucose, however I would document my decision to not give it (mentioning the alert, stable, etc) and I have yet for it to be an issue. But again it depends on who you work for, my service tends to allow us to make our decisions when working with patients if we can properly justify why we did or did not do something.

 

[mycrofft]

Don't treat a verbal blood glucose.

And here's a curve. Folks with malabsorptive conditions like status post Roux en Y bariatric surgery, partial GI removal from GSW or CA, etc may exhibit dumping syndrome after eating too much sugar. Blood sugar drops in response, so we run in and give more sugar. Like combating an Antabuse reaction with more alcohol.

When people tell you what their blood glucoses nrmally are, smile and stick 'em, then stick to your polrtocols. And look for a MedicAlert bracelet.