Diabetic Emergency Question

[TKO]

I couldn't find anything relevant about oral glucose on the Canadian Diabetes Association's site. If you can find that paper, post it, because I'm curious now.

Will do!

Google isn't nearly as effective as it used to be....this was all I could find from here and it's not descriptive enough. It's the same question.

http://www.diabetes.ca/cpg2003/downloads/hypoglycemia.pdf and then scroll to the bottom of the first page, under the paragraph "Treatment of Hypoglycemia" where it states that Glucogel must be swallowed to be significantly effective.

 

[Meursault]

That handout cites four papers for the ineffectiveness of oral glucose. I wasn't, unfortunately, able to get the full text because they were all published some time ago. Two were published in JAMA ~30 years ago and indicate that oral glucose doesn't change serum glucose much unless swallowed, which is exactly what the handout said.

Interestingly, one of them specifically tested absorption through the buccal mucosa by radiolabeling and found almost nothing reaches the bloodstream.

I'm still looking for newer research, but it seems that glucose is effective, but it has to be swallowed, and it's a little slow for prehospital care (blood glucose rise of 3.1 mg/dL/minute in another study).

 

[TKO]

and yet, most of us have personal experiences with glucogel that suggests the opposite is true.

 

[griz1974]

oral glucose

you can not give oral glucose if pt is unresponsive it cause an air way abstructsion do abcs and call als and transport asap

 

[mikie]

BLS here: glucagon, IM

 

[Ops Paramedic]

So who wrote the protocol?? (our BLS protocol here is along the same lines) It is most likely that by the time the ambo service is called for a hypoglyceamic pt, the pt will have a dercreased LOC?? So they want you to go and service the call, but in the same breath they are "contra indicating" you...

The answer to your poll is not on the list of choices. Call your back-up and get going to hospital. Monitor your ABCs & vitals etc. and transport lateral. Your Back-up could meet you en route.

 

[paramedix]

If the patient is unresponsive and lateral... why can't you put small amounts of glucogel on the outside of the gums?

 

[fma08]

officially dont do anything to compromise the pt's airway, i.e. giving oral glucose to an unresponsive pt. unofficially, we were taught in basic that, if carefully done, some oral glucose can be given through the buccal rout. So its up to you to decide. Get ALS coming for sure because there's nothing like some D-50 for hypoglycemia.

 

[Jayxbird521]

it could be do to other things as well not just diabetic

 

[Firesurfer75]

Administering glucose could kill 'em from the sounds of the scenerio.. check BGL. Don't admin anything oral when pt is unconcious, regardless of how small the object is. I'd say maintain airway, check BGL and seek ALS via on-scene or hospital.

 

[TKO]

Ok, not to contradict myself, but rolling a pt into the lateral recumbent position and applying some glucogel into the buccal space is a good idea. The pt will just drool the excess out anyway and the airway will be fine. If even a small amount gets in there, that's a good thing.

Remember that diabetics have microvascular issues and are very prone to infections, so don't rely on Dextrose in water to save their butt, as for one thing, they're burning brain cells on your clock. And if the medic pooches the line (because those veins are tricky) and D50 goes interstitial, then the pt could lose the extremity. We absolutely have to be aware of the pts quality of life as a result of our actions.

So a little intervention isn't going to hurt the pt whether it works or not. Just so long as they aren't supine, they're ok for glucogel. Don't withhold that little amount because someone says it's contraindicated in UnCx; get verification on that from your rule makers, because done properly it is a harmless attempt to use the only tool some BLS providers have.

And remember, high-flow 02 too! Eliminate that acidosis.

 

[skyemt]

Ok, not to contradict myself, but rolling a pt into the lateral recumbent position and applying some glucogel into the buccal space is a good idea. The pt will just drool the excess out anyway and the airway will be fine. If even a small amount gets in there, that's a good thing.

Remember that diabetics have microvascular issues and are very prone to infections, so don't rely on Dextrose in water to save their butt, as for one thing, they're burning brain cells on your clock. And if the medic pooches the line (because those veins are tricky) and D50 goes interstitial, then the pt could lose the extremity. We absolutely have to be aware of the pts quality of life as a result of our actions.

So a little intervention isn't going to hurt the pt whether it works or not. Just so long as they aren't supine, they're ok for glucogel. Don't withhold that little amount because someone says it's contraindicated in UnCx; get verification on that from your rule makers, because done properly it is a harmless attempt to use the only tool some BLS providers have.

And remember, high-flow 02 too! Eliminate that acidosis.

sure, sounds great... would you like to rewrite many of the protocols that say we can not give oral glucose to a pt that is unresponsive?

 

[TKO]

Sure would!!! LOL!

Sorry, but as I said in the above, find out from the powers that be for this specific method of glucogel delivery before attempting. More times than not, there's nothing against it specifically.

Where I live (BC) we are beginning Treatment Guidelines; the concept is thinking outside the box with respect to pt treatments. If it isn't going to make the pt worse, then there's no harm not to try it. So AED for small children, for example, if it's not blunt trauma, electrical or cardiac hx then we couldn't shock. But with Treatment Guidelines, if you've done everything else and CPR alone isn't working, then we can use the AED. It isn't going to do any worse.

That's just the official changes, pretty well every EMS practicioner everywhere has been adapting to a bad situation within tolerance levels since EMS started interventions and treatments.

Back to the point, seriously, roll your UnCx pt onto their side and admin some glucogel (5-10 g) into the buccal pouch. Have suction standing by. This just isn't a harmful treatment. It's like new ways of applying dressings.

PENDING APPROVAL, of course!

 

[BossyCow]

We can act outside of our protcols with a simple phone call to medical control explaining the situation and the precautions we will take. If I called and told the doc that I wanted permission to do what TKO described and let them know that I had no ALS available, and gave the estimated time until I could meet with ALS, I would most likely be given permission.

Protocols are not Must Do's in every instance. They are guidelines and most systems have another protocol regarding those gray areas.