Another strange diabetic call

[lightsandsirens5]

Well, that other thread about an interesting DM pt reminded me of a call I had a while ago. I didn't want to completely hijack the other thread, so here's mine.

60ish yom. Initially found lying "sprawled out" supine on his bed. Sweaty, warm. Bigger pt, maybe 300 lbs. Initial BGL of 12. Got a line and admin 25ml of D50. After 5 min BGl was up to 60. No change in LOC. Admin 25 more of D50. BGL came up to 190. Pt became responsive to loud verbal at this point, but was not A&O by any streach of the imagination. We loaded him up and began transport. During transport, I twice gave 25ml of D50 which brought his BGL up to 310 and brought him back to A&Ox4. Within 10 minutes though, he had dropped to 200 and was no longer A&O. When he dropped below 150 a while later, I gave 25 more per med control and got a BGL of 200+. He was then A&O for the remaining 20-30 minutes of transport and maintained a stable BGL the whole time. I gave a total of 125ml of D50, but only the last 25 seemed to work as advertised. Could it be because he was so low to start his body used it up right off the bat and by the time I gave him the last 25 he was good to go and didn't use it right away? I just didn't understand how I could give 125ml and only end up with a BGL of around 200. I have given 25-50 before and seen it go from BGL of 20 in a comatose pt to an A&Ox4 pt by the time I can push it all and a BGL of 345 within 5 mins.

Any ideas?

 

[colafdp]

I suppose that could be it. His body could have just used up the dextrose as it went into his body, which resulted in the glucose dropping again, until you topped him up so to speak. What's with these patients not reading the textbook? lol

 

[EMT11KDL]

I had a similar thing about two or three weeks back, My patient did not eat or drink anything since 7p the night before, its now 1p in the next day. He had taken his insulin shot the night before and this morning. Due to he was on an empty stomach and had no sugar. And when we pushed d50, his sugar went up and than dropped dramatically. and we had to push again. Your patient might have taken his insulin without eating,

Also, what is his baseline for his BG, some people run higher than normal and some run lower. Without getting a good history from the patient, there could be many causes for this

 

[mgr22]

Any chance the line infiltrated? Also, from where were you sampling blood?

 

[Aidey]

I think this may be a case of treat the patient, not the numbers.

It is possible that "normal" for this patient is 200. Some people with uncontrolled or poorly controlled diabetes will start to exhibit hypoglycemic symptoms at much higher numbers, and that may have been what was going on here.

Also, what type of glucometer are you using? I have never seen a glucometer that will give a number below 20mg/dl.

 

[MSDeltaFlt]

Well, that other thread about an interesting DM pt reminded me of a call I had a while ago. I didn't want to completely hijack the other thread, so here's mine.

60ish yom. Initially found lying "sprawled out" supine on his bed. Sweaty, warm. Bigger pt, maybe 300 lbs. Initial BGL of 12. Got a line and admin 25ml of D50. After 5 min BGl was up to 60. No change in LOC. Admin 25 more of D50. BGL came up to 190. Pt became responsive to loud verbal at this point, but was not A&O by any streach of the imagination. We loaded him up and began transport. During transport, I twice gave 25ml of D50 which brought his BGL up to 310 and brought him back to A&Ox4. Within 10 minutes though, he had dropped to 200 and was no longer A&O. When he dropped below 150 a while later, I gave 25 more per med control and got a BGL of 200+. He was then A&O for the remaining 20-30 minutes of transport and maintained a stable BGL the whole time. I gave a total of 125ml of D50, but only the last 25 seemed to work as advertised. Could it be because he was so low to start his body used it up right off the bat and by the time I gave him the last 25 he was good to go and didn't use it right away? I just didn't understand how I could give 125ml and only end up with a BGL of around 200. I have given 25-50 before and seen it go from BGL of 20 in a comatose pt to an A&Ox4 pt by the time I can push it all and a BGL of 345 within 5 mins.

Any ideas?

There are multiple reasons why your pt's sugar could be so stubborn. Infection is one that can really throw a pt's sugar off. Plus does he take insulin? If so, what kind? If it was a long acting insulin like Lantus, their blood sugar could stay low despite multiple doses of D50 and even a maintenance infusion of a D10 drip in the hospital if they took it and didn't need it or even they took it and they are having an infection of some sort. Because Diabetics with infections tend to have a hard time keeping their blood sugar regulated. The link below is for Lantus. It's a once a day insulin med, so one needs to be on top of their blood sugar when they take it.

(www.nlm.nih.gov)

 

[lightsandsirens5]

Also, what type of glucometer are you using? I have never seen a glucometer that will give a number below 20mg/dl.

That was supposed to be 21, not 12. And I don't know what we are useing. I'll check next time I'm on and let you know. So far as I know, they will read lower than 20, but I could be wrong.

 

[Aidey]

Ok, fair enough. I can't remember a glucometer I've used that didn't just read "low" for anything under 20mg/dl. Even the big Accu-Checks the hospital in my area use cut off at 20. I'm not saying they don't exist, just that I'm curious what the brand is, since I haven't run into that before.