# Oral Glucouse



## musicislife (May 20, 2012)

A few questions: 

My friend (1st Responder as well) gave a woman some OG because she was not feeling right while running a biathalon (i did not find out signs and symptms, but she was not a diabetic). Can this happen? Would I look for the same signs of hypoglycmia in a non diabetic person?

If I administer it to a patient (lets say he fainted) because he is a diabetic and I suspect hypoglycemia, but I suspected wrong...would that do any damage? 

An emt said to me the stuff is one of those things that can do no harm, only good. Is that true?


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## Epi-do (May 20, 2012)

Actually, they have found that large spikes in blood sugar can and do have consequences.  In fact, if your blood sugar spikes to over 140, you can have inflammation of your blood vessels and organs.  The longer and higher the spike, the greater the effects upon your body.  Over time, repeated spikes can have long term damage on your body.

This is why, at least in my area, we no longer give a full amp of D-50 to a patient, but rather, dose them according to their actual blood sugar at the time we test it.  

Just like anything else we give, there are very real consequences to giving oral glucose (or D-50) to any patient.  Nothing we do is benign, despite what you may be told.


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## workworkwork (May 20, 2012)

too much of anything is never a good thing.

even oxygen can be harmful to nasopharynx and oropharynx as it can dry out the passages and become uncomfortable if it is prolonged and not humidified. granted its not as bad as shocking someone when you shouldn't etc.

another contraindication to glucose is suspected stroke. if someone was experiencing a TIA/CVA is would be a bad move to administer glucose. i'm going to go ahead and assume her speech wasn't slurred and her face wasn't drooping.

in that situation, i would have thought dehydration or heat exhaustion / heat stroke. visualize if there's sweat, their temperature etc. rest, fluids, rescue blanket and/or maybe a few minutes in the back with A/C would have been the options I'd go through.


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## Hunter (May 20, 2012)

workworkwork said:


> too much of anything is never a good thing.
> 
> even oxygen can be harmful to nasopharynx and oropharynx as it can dry out the passages and become uncomfortable if it is prolonged and not humidified. granted its not as bad as shocking someone when you shouldn't etc.
> 
> ...



why is tia\cva a contra indication for glucose. I know it is for D50 but never heard the glucose thing before.


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## medichopeful (May 20, 2012)

musicislife said:


> An emt said to me the stuff is one of those things that can do no harm, only good. Is that true?



Absolutely not.  Although oral glucose is readily available in many other, non-medication places, it's a drug, and needs to be treated as such.


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## medichopeful (May 20, 2012)

workworkwork said:


> too much of anything is never a good thing.
> 
> even oxygen can be harmful to nasopharynx and oropharynx as it can dry out the passages and become uncomfortable if it is prolonged and not humidified. granted its not as bad as shocking someone when you shouldn't etc.



There's also other issues that can come about from oxygen, but I like how patient comfort is one of the first things you wrote about


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## Hunter (May 20, 2012)

medichopeful said:


> There's also other issues that can come about from oxygen, but I like how patient comfort is one of the first things you wrote about



Increases icp in high concentrations no?


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## workworkwork (May 20, 2012)

medichopeful said:


> There's also other issues that can come about from oxygen, but I like how patient comfort is one of the first things you wrote about


i try!


Hunter said:


> why is tia\cva a contra indication for glucose. I know it is for D50 but never heard the glucose thing before.


i actually had to lookup what D50 is, as we don't have that in MA, at least not at my company. we just have glutose. on my pharm table from my cert class its marked off as a contraindication, my first thought would be because you don't know what kind of stroke it is, raising blood sugar levels for a hemorrhagic stroke doesn't sound right to me. this is my first scrape in the medical field so i'm still learning on the origins of inner workings of our protocols (only been at it 6 months)


Hunter said:


> Increases icp in high concentrations no?


i know you're supposed to induce hyperventilation via BVM to avoid herniation via the foramen magnum, but that reduces CO2 levels i believe?.. am i wrong?


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## medichopeful (May 20, 2012)

Hunter said:


> Increases icp in high concentrations no?



I've never heard this that I can recall, but that doesn't mean it's not true!

I was more focused on respiratory issues when I said this (for example, absorption atelectasis, etc)


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## Hunter (May 20, 2012)

medichopeful said:


> I've never heard this that I can recall, but that doesn't mean it's not true!
> 
> I was more focused on respiratory issues when I said this (for example, absorption atelectasis, etc)



Well I know that o2 causes vasoconstriction. I don't have the research on hand but I'll look it up.


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## medichopeful (May 20, 2012)

workworkwork said:


> i know you're supposed to induce hyperventilation via BVM to avoid herniation via the foramen magnum, but that reduces CO2 levels i believe?.. am i wrong?



Hyperventilation does reduce CO2 levels, which causes vasoconstriction.  As far as using it for reduction of ICP, it is in the MA State Protocols, though a paramedic friend of mine says it's not suggested anymore (though I haven't come up with a definitive answer for whether he misspoke or not! I'll add it to my list of things to research more in-depth)


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## medichopeful (May 20, 2012)

Hunter said:


> Well I know that o2 causes vasoconstriction. I don't have the research on hand but I'll look it up.



I'd love to see it!  I know lack of O2 causes vasodilation, so going the other way  I could potentially see that.


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## workworkwork (May 20, 2012)

medichopeful said:


> Hyperventilation does reduce CO2 levels, which causes vasoconstriction.  As far as using it for reduction of ICP, it is in the MA State Protocols, though a paramedic friend of mine says it's not suggested anymore (though I haven't come up with a definitive answer for whether he misspoke or not! I'll add it to my list of things to research more in-depth)


hmm, i'll check up on that too, though i've had several protocol update emails, maybe i missed it. my class was in 2011 if that makes a difference.


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## medichopeful (May 20, 2012)

workworkwork said:


> hmm, i'll check up on that too, though i've had several protocol update emails, maybe i missed it. my class was in 2011 if that makes a difference.



There's definitely a chance he just didn't speak correctly, it happens.  I did a bit of searching a while back, but can't really remember what I found!  Though I do seem to recall him stating an AHA article that I wasn't able to find...


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## TheGodfather (May 20, 2012)

Respiratory alkalosis _will_ cause increases of ICP. With that said, oxygen in and of itself may or may not always cause ICP spikes.... it really is most determined on the patients pH; specifically PaCO2.

Also, in the head injured patient, this causes a "robin hood effect"... 

Example:

A head-injured patient has brain tissue that is both ischemic and non-ischemic --> Healthy areas of brain      vasoconstricts  and push oxygenated blood to      injured areas of the brain. --> leads to further ischemia and "oxygen steal" from the non-affected areas.

Mild vasoconstriction, though, is beneficial to the patient with increased ICP to prevent herniation for ways that I'm sure you already understand...

That's why it is now recognized as standard of care to maintain ETCO2 as nearest to 35mmHg (or, some might agree between about 32-35mmHg) in these situations (but you must be verrrrrrry cautious).


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## medichopeful (May 20, 2012)

TheGodfather said:


> Respiratory alkalosis _will_ cause increases of ICP.




Am I reading this wrong or was this misstated? Did you mean to say respiratory alkalosis will cause _decreased_ ICP?


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## TheGodfather (May 20, 2012)

medichopeful said:


> Am I reading this wrong or was this misstated? Did you mean to say respiratory alkalosis will cause _decreased_ ICP?



sorry, yes my mistake.. i was too far on the topic of decreased cerebral perfusion that i confused myself in the process...

correction: respiratory alkalosis will result in decreases of ICP at the cost of cerebral perfusion, and respiratory _acidosis_ (or physiologic "norms") = ICP increased due to underlying TBI and/or vasodilation


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## medichopeful (May 20, 2012)

TheGodfather said:


> sorry, yes my mistake.. i was too far on the topic of decreased cerebral perfusion that i confused myself in the process...
> 
> correction: respiratory alkalosis will result in decreases of ICP at the cost of cerebral perfusion, and respiratory _acidosis_ (or physiologic "norms") = ICP increased due to underlying TBI and/or vasodilation



I thought it might be a mistake, but I was all sorts of confused for a second!


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## TheGodfather (May 20, 2012)

medichopeful said:


> I thought it might be a mistake, but I was all sorts of confused for a second!



I know the feeling... I have the habit of confusing myself quite regularly! :blush:

I guess that's what I deserve for getting distracted from my studies to check back on here... Brain mush!


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## Hunter (May 20, 2012)

TheGodfather said:


> I know the feeling... I have the habit of confusing myself quite regularly! :blush:
> 
> I guess that's what I deserve for getting distracted from my studies to check back on here... Brain mush!



Lol... I'm studying for my state medics, this place keeps me from going crazy. o.o


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## musicislife (May 20, 2012)

NJ First Responders: can they administer oral glucouse?


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## DrParasite (May 20, 2012)

Unless you are a member of law enforcement (and even then it's questionable), New Jersey Dept of Health no longer has a first responder program.

If you are a first responder certified person in NJ, you are certified by the National Safety Council or some other random agency, not the NJ agency that sets regulations for EMTs and Paramedics.


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## workworkwork (May 21, 2012)

after thinking about this scenario a bit more it rubs me the wrong way.

a first responder administering glucose during a sporting event for an unknown medical issue for a non diabetic?


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## mycrofft (May 21, 2012)

Like "Here, want some Gatorade?".:rofl: Am Red Cross lay first aiders can administer food or orange juice (where did that fixation come from, OJ....?).
 Harmless in and of itself, except unless it signals a willful departure from protocols. Then it could become handing out sunscreen, or allergy tablets, or splinting for no good reason. Sort of "Glucose as a gateway drug".

Or if they have dumping syndrome.


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## musicislife (May 21, 2012)

idk, thats what my friend did (there was no gatorade around, just water) worked just fine, because the pt was experiencing signs of hypoglycemia


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## medichopeful (May 21, 2012)

musicislife said:


> idk, thats what my friend did (there was no gatorade around, just water) worked just fine, because the pt was experiencing signs of hypoglycemia



I'm not second guessing what was done, but one thing that must be considered when treating someone is that many signs or symptoms of one disorder or disease are also signs and symptoms of another.


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## Tigger (May 21, 2012)

musicislife said:


> idk, thats what my friend did (there was no gatorade around, just water) worked just fine, because the pt was experiencing signs of hypoglycemia



Signs of hypoglycemia do not by themselves indicate that some is suffering from hypoglycemia though. Maybe the person's sugar was low and that's what they needed or maybe they felt better because some gave them a medication. Personally I think it's a rather poor practice to give glucose to anyone potentially showing signs of hypoglycemia. No drug is benign and while it's likely that there were no ill effects in this particular case, how about calling for EMS next time and getting a BGL and a more proper assessment?


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## mycrofft (May 21, 2012)

OP can't get a blood glucose, he's a first aider or first responder. Some glucose (not a big bolus of D50 or whatever, just some OJ like the red cross says?) is not going to hurt unless the pt vomits it back up while lying down and it embarrasses the airway.

OP, what were the pt's complaints which led your friend to give the runner something to drink or eat that suggested hypoglycemia? 

Again, some sugar unless it affects airway (obtunded pt) is not going to hurt the pt, maybe/unless they are experiencing dumping syndrome (ask if they get it, if they have had a gastric bypass, etc).


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## Tigger (May 21, 2012)

mycrofft said:


> OP can't get a blood glucose, he's a first aider or first responder. Some glucose (not a big bolus of D50 or whatever, just some OJ like the red cross says?) is not going to hurt unless the pt vomits it back up while lying down and it embarrasses the airway.
> 
> OP, what were the pt's complaints which led your friend to give the runner something to drink or eat that suggested hypoglycemia?
> 
> Again, some sugar unless it affects airway (obtunded pt) is not going to hurt the pt, maybe/unless they are experiencing dumping syndrome (ask if they get it, if they have had a gastric bypass, etc).



I realize that, hence "call EMS" .

The sugar might be harmless, but that doesn't need we need to be giving medications to patients just because we can.


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## musicislife (May 21, 2012)

I believe she was acting strange. She noticed an improvement to the pt's condition, so thats probably why she didnt radio for the rig to come over.


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## mycrofft (May 22, 2012)

*Tigger's right*

I'd call "the rig" for any alteration in behavior like that. Could drink your OJ, say "Thanks", stand up then collapse with a stroke, or a bad heart valve, or heat exhaustion, etc etc. Altered LOC is a reason to call in the cavalry.


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## musicislife (May 22, 2012)

what are the odds of coming across a patient who is a non diabetic with hypoglycemia? How would this occur?


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## Epi-do (May 22, 2012)

Given the right circumstances, anyone's blood sugar can become low.  However, when this happens to most people, once they begin feeling off, "funny", or what have you, they think to themselves, "Wow!  I don't feel right!  I really need to eat something," and get something to fix the problem.

As for seeing a patient that is a "non diabetic" - it could be that they have yet to be diagnosed.  It could just be that someone didn't eat soon enough after already running on empty and then doing strenuous activity.  It could be something else completely.

The endocrine system is very complex, and there could be countless factors playing into a random, one-time episode of low blood sugar.


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## Akulahawk (May 22, 2012)

musicislife said:


> what are the odds of coming across a patient who is a non diabetic with hypoglycemia? How would this occur?





Epi-do said:


> Given the right circumstances, anyone's blood sugar can become low.  However, when this happens to most people, once they begin feeling off, "funny", or what have you, they think to themselves, "Wow!  I don't feel right!  I really need to eat something," and get something to fix the problem.
> 
> As for seeing a patient that is a "non diabetic" - it could be that they have yet to be diagnosed.  It could just be that someone didn't eat soon enough after already running on empty and then doing strenuous activity.  It could be something else completely.
> 
> The endocrine system is very complex, and there could be countless factors playing into a random, one-time episode of low blood sugar.


I'm not a diabetic... but I know the feeling of running low. Basically, I just don't feel right and I have to eat something that is sweet. I've never had my blood sugar tested during those moments, but it's pretty clear that I'm starting to get low. It used to happen more frequently when I was far more active and I'd burn off a lot of my body's glucose and "bonk." The symptoms I have when I run low are very similar to when I bonk. When I get to that point, I am still in full control of my faculties, and I seek out a sugary drink and then seek out something with protein. 

That's before I start to run really low and get into the agitation and nervousness...


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## Akulahawk (May 22, 2012)

Altered LOC in the setting of heat illness should really drive up your suspicion of heatstroke. Heat exhaustion and heatstroke can blend together so you might see more signs of one and not the other until the patient is well into heatstroke. 

What gets fun figuring out is when your patient is exhibiting signs of heat exhaustion, heatstroke, and is bonking because of athletic activity...


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## mycrofft (May 23, 2012)

But in this OP's case, just call for reinforcements, get the pt cooled off, and don't do anything rash like giving oral anything to someone who is losing consciousness.
I found an article about hypoglycemia per se (not as a diabetic affect exclusively) and posted it elsewhere tonight.


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## Christopher (May 23, 2012)

musicislife said:


> I believe she was acting strange. She noticed an improvement to the pt's condition, so thats probably why she didnt radio for the rig to come over.



After a race they likely are hypoglycemic, dehydrated, and somewhere on the heat exhaustion scale...

Water, electrolyte replacement, some carbs and maybe some sugar. Move them to a cool place.

Do they need EMS? I've worked some iron distance triathalons and my notion of "big sick" versus "little sick" got quite the shock. Simple AMS that doesn't improve with rest, rehydration, and food is probably going to concern me...otherwise they'll be fine.


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## Tigger (May 23, 2012)

Christopher said:


> After a race they likely are hypoglycemic, dehydrated, and somewhere on the heat exhaustion scale...
> 
> Water, electrolyte replacement, some carbs and maybe some sugar. Move them to a cool place.
> 
> Do they need EMS? I've worked some iron distance triathalons and my notion of "big sick" versus "little sick" got quite the shock. Simple AMS that doesn't improve with rest, rehydration, and food is probably going to concern me...otherwise they'll be fine.



Agreed, many athletes at the end of any sort of race are going to be a mess. We have NCAA cross country race every year and it's always a mess at the finish line; AMS, vomiting, Asthma attacks, dehydration, heat exhaustion, the works. Most of this clears up relatively quickly, but if you're working an event like this you need to be prepared to manage a patient that doesn't come around. I'd argue that a single first responder is likely not capable of this. At our race we have 5-6 EMTs, an athletic trainer, and 3-4 aides that help us move people into treatment areas. We have a medic unit posted nearby as well.


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## Brandon O (May 23, 2012)

musicislife said:


> what are the odds of coming across a patient who is a non diabetic with hypoglycemia? How would this occur?



Medication error.


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## DeepFreeze (Jun 11, 2012)

workworkwork said:


> i try!
> 
> i actually had to lookup what D50 is, as we don't have that in MA, at least not at my company.



Not to derail but...but I've seen it refereed to that both on the northshore (lynn specifically) and in Metro-Boston at two different ambulance companies.


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## JPINFV (Jun 11, 2012)

musicislife said:


> what are the odds of coming across a patient who is a non diabetic with hypoglycemia? How would this occur?




An insulinoma would be another cause.


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## AnthonyTheEmt (Jun 14, 2012)

musicislife said:


> A few questions:
> 
> 
> If I administer it to a patient (lets say he fainted) because he is a diabetic and I suspect hypoglycemia, but I suspected wrong...would that do any damage?



Yes it would potentially do damage. If the patient has fainted, you sure as hell better not give oral glucose because they cannot protect their airway.


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## JPINFV (Jun 14, 2012)

AnthonyTheEmt said:


> Yes it would potentially do damage. If the patient has fainted, you sure as hell better not give oral glucose because they cannot protect their airway.



Of course if the patient is significantly altered because of hypoglycemia, then you have the same airway issue. All other things being equal, oral glucose isn't any more harmful if given to someone who isn't hypoglycemic than it is to give to someone who is hypoglycemic.


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## Melclin (Jun 15, 2012)

The amount of glucose in a 15g tube is minuscule.

About two mouth fulls of apple juice. I'd be willing to bet you could give 125mls of apple juice to pretty much anyone and it wouldn't hurt them. Assuming they can swallow the stuff.


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## Brandon O (Jun 15, 2012)

I have found a reference which swears 15g of oral glucose should raise the circulating BGL by 50 mg/dL (that's about 2.8 mmol/dL for you furriners) within about 15 minutes, but I have never found that to be remotely true.


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## heatherabel3 (Jun 16, 2012)

The amount of glucose given will raise each persons BGL differently. If you give my kid a full tube of glucose your gonna send his sugar through the roof. The last time he needed it his BG was 22 and a tube and 15 mins later he was at 338. Of course, we deal with the high because its better than a coma but it makes him feel really bad so we never dose an entire tube if we can help it.  So yeah, different people...different responses.


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## VirginiaEMT (Jun 16, 2012)

Hunter said:


> why is tia\cva a contra indication for glucose. I know it is for D50 but never heard the glucose thing before.



Dextrose is a "hypertonic" solution that can cause an increase in the pressure in the cranium by causing more fluid to accumulate in the space occupied by the brain. This is a elementary explanation but I would suggest you google the words isotonic, hypotonic, and hypertonic solutions. That will give you a better idea.


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