Diabetic emergency with pt. on beta blocker.

Pittsburgh77

Pittsburgh77

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Okay, so let's say you're dispatched to a diabetic emergency at your local nursing home. While obtaining baseline set of vitals, you get a reading for the BGL of 20. You follow standard locol protocol, and while administering amp of D-50, a CNA on site thinks the pt. may be on a Beta blocker. You re-evaluate your pt. without any noted improvement.

Would you consider administering Glucagon [Beta-adrenergic antagonist] IV, to allow for the D-50 to take its effects?


I was presented with this scenerio from my partner, and wasn't 100% on my answer;;; so what better place to turn to than the EMT LIFE Forums?!

And, can someone please describe the "battle" between Beta blockers & D-50?

Thanks guys.
 
Beta blockers don't quite work that way.

Think about what the sympathetic response does to BGL.

Now consider what will happen when you block it?

Will this affect exogenous sources of sugar such as D50?

Edit:
Alternatively,

Assuming that a car is in park, does the status of the gas pedal affect your ability to put gas into a gas tank or just the ability to keep the gas tank full?

Finally, glucagon is not a beta-adrenergic antagonist. Even if it did bind to beta receptors, due to its action it still wouldn't be an antagonist.
 
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Also, glucagon doesn't make dextrose work. Give the D50 time to work, re-check their blood sugar, and give them more dextrose if necessary.
 
JPINV and Aidey covered most of my thoughts on this subject. I'd just add that your patient might not have been as aware as usual that his/her sugar was getting low, due to the beta-blockers. Also, if I give D50 to a patient whom I believe is profoundly hypoglycemic and I see no improvement, I'd be concerned that (1) my line might not be patent and (2) my glucometer reading might not have been accurate.
 
mgr22 said:
JPINV and Aidey covered most of my thoughts on this subject. I'd just add that your patient might not have been as aware as usual that his/her sugar was getting low, due to the beta-blockers. Also, if I give D50 to a patient whom I believe is profoundly hypoglycemic and I see no improvement, I'd be concerned that (1) my line might not be patent and (2) my glucometer reading might not have been accurate.
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or (3) I haven't waited long enough yet. Sometimes it just takes a little bit for the brain to kick back in, or maybe it takes a second 25g of D50.

It should be really, really clear whether the line's patent well before the patient doesn't wake up after the D50's given.
 
Beta blockers will not affect the cells ability to use glucose. If the patient did not respond to D50 they are not going to respond to glucagon. If the BG level is within normal limits after the D50 and the patient is still not alert than I would start looking for some other cause to the altered mental status.

Beta-blockers can have effect on the glucose level as they can inhibit the bodies mechanisms for maintaining proper glucose levels. They can inhibit hepatic stimulation (ie glycogenolysis). Remember, catacholamines stimulate release of glucose and beta-blockers block some of these catacholamines effects so your not gonna get the same level of stimulation.

As someone else mentioned beta-blockers can cause a "hypoglycemia unawareness" which is where the beta-blocker takes away the bodies response to a falling blood sugar level. Patient's who become hypoglycemic have increased heart rates, sweating, and feel jittery from the catacholamine release. When the beta-blocker blocks these catacholsmines the patient does not feel (or feel them as greatly) the warning signs and can succumb without warning.

Hypoglycemia Unawareness is mostly a concern with the non-selective beta-blockers such as propanolol. The more cardio-selective blockers usually do not cause this issue. Although some studies done say the non-selective are very unlikely to cause issue... but is still something worth being aware of.

And, can someone please describe the "battle" between Beta blockers & D-50
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In the acute phase of treating a patient with hypoglycemia there is no "battle between beta blockers and D50". The patient will use the D50 the same as any other patient not taking a beta-blocker. There is a slight "battle" between beta-blockers and glucose release that can contribute to a patient becoming hypoglycemic which I touched on above.

I admit the ANS gets a bit confusing at times and I have to take 5 mins to review before it all becomes clear again.

Sorry for getting a bit wordy... it helps me to refresh and recall as I try to explain...
 
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Pittsburgh77 said:
Would you consider administering Glucagon [Beta-adrenergic antagonist] IV, to allow for the D-50 to take its effects?
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In the situation you posted, I would NOT consider giving Glucagon. I'd administer another 25g of glucose via ye olde D50 IV. It sometimes just takes the brain a few minutes to get going again. IV Glucagon is a (if not the) front line treatment for beta-blocker OD. What you've described is a hypoglycemic patient who happens to also take beta-blockers. This leads me to assume (for the purpose of this exercise) that your patient is otherwise of normal-ish vitals, just has low blood glucose levels.
 
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