Drugs for Diabetic

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trauma1534

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I had a run in with an ER nurse this past weekend... we brought in a Hypoglycemic patient, when we picked them up, they were unresponsive with a blood sugar of 51. I want to know what different protocols say about this.

This is what happened.. tell me what you would have done in this situation.

As I said, the patient was unresponsive.. family reports that they have been this way for about 3-4 hours. Then they decided to call 911 (hmmmm wonder why???!!!) We went in got the sugar level, attempted to start an IV for D-50. All we carry on our trucks for IV fluids is Normal Saline. After 2 tries, IV was unsuccessful, so we gave 1mg Glucagon SQ. We then attempted to get another IV, it was successful... before we could get it taped down, he started to come around, moved his arm and pulled the line. Got him loaded in the truck, while enroute, got a line established.. got another Blood Sugar Level of 114. Went ahead and pushed D-50. after 10 min. rechecked sugar, it was now 314.

Got him in the ER, reported to the nurse, turned patient over, and started writing report. Nurse came in and asked why we gave Glucagon and followed it with D-50. We told him that it was our protocol. He said that he had never heard of it. Demanded to see our protocol book... said that the patient's level was now 540.

How many would have done the same thing? Who disagrees and why?
 
Personally, I would not had adminster the D50W, since you treated with Glucagon. I too have never seen adminsteration of D50W after Glucagon, unless the reading continues to be low after absorption of Glucagon. Usually it is either or..

Be safe,
R/R 911
 
I would have to disagree with your logic. Just because a protocol is written a certain way does not make it stone. With the patient's blood sugar increased by the Glucagon, I would not administer D50. Ecspecially since it seems that his mentation improved as well. Remember hyperglycemic events are just as dangerous as hypoglycemic events.
 
If the BG level was 114mg/dl after Glucagon why would you push D50? 114mg/dl is a normal BG level so I also dont understand why you would give D50 when pt. is showing response(ie. > BG level, LOC improvment) to the Glucagon. If the BG level didnt rise much or say the 114 didnt maintain and fell rather quickly then yeah I would proceed with D50 to since maybe pt. doesnt have the glycogen stores for the Glucagon to really work on to do much good.

But sounds like nurse may have been giving you a hard time. BG of 540 is high but given D50 is metabolized quick and a bolus of NSS works well to bring it down I surely wouldnt panic.
 
I'm with everyone else here:

The patient was improving, so why give the D50. I'd have secured a patent IV and been prepared to give the D50 if needed, but I'd be happy with a BGl of 114 (was that IV or fingerstick??).

Jon
 
I'm with everyone else...That sounds counterproductive...

Normal BGL: 80-120mg/dl

Your patient: 114....Seems normal to me, and he was coming around....

I guess the way I was taught, and look at is is this...If the patient has good abc's, and is CAOX3, hemodynamically stable, why give MORE drugs? I mean, obviously there are situations, but why add another variable to an already complex equation.

I guess I was raised old school, and that's a tribute to good teachers(all older medics). I was taught to stay out of the drug box. New medics seem to be quite drug box happy recently. Granted, I'm new. :) I digress..

Sorry for the tangent. I'm with the group on this one.
 
I thought what was important after glucagon was to make sure the patient got food, since their glucose stores are now depleted, but not to keep giving sugar?
 
It is good to hear everyone elses Idea's on this matter... however here is why we do Glucagon and D50. We were taught that Glucagon is only a temp. fix. It releases all the glycogen from the liver. The EMS Field guide and our protocol's state under Glucagon, aftter administration of Glucagon, it is important that the patient eats carbohidrates or is administered D50 as soon as possible. When the blood sugar level shoots up after giving either or both of these drugs, it is only for a short time as it all has to matabilize... well the D50 that is. The Glucagon only uses what is already in the body... ie.. bringing the patient around long enough to continue definative treatment. Make since? That is what we have been taught. We were taught to be very agressive. Might I add also that our transport time on this call to the nearest ER was 35 min.
 
That kinda does make sense however I personally would have monitored the patient and consulted with medical command prior to giving the D50. Protocol is protocol, but the patient is the patient to... know what I mean?
 
Treat the patient not the equiptment/protocol right?

I do see, and understand the physiological effects of glucogon, why you guys would give D50, but I agree with RecueTech...
 
Originally posted by Strike3@Dec 9 2005, 10:48 AM
Treat the patient not the equiptment/protocol right?

I do see, and understand the physiological effects of glucogon, why you guys would give D50, but I agree with RecueTech...
Click to expand...
thats the answer..treat the pt. If the pt was aao*3, no further treatments were necessary IMO
 
Actually, glucagon should last at least 25 -30 minutes, if given I.M. maybe longer than the D50W. Also along withhigh carbohydrates, protein is just as important to be able to last longer. I would suggest a protocol review, an repeat a FSBS after admisteration of either D50W or Glucagon was admistered ( post 15 minutes). Dependent on the level & L.O.C. if further intervention is needed.

Be safe,
R/R 911
 
If the pt. is conscious after Glucagon administration with an acceptable BGL, I'd leave it be. Check it every 5 minutes until arrival, treat if BGL drops again...
 
Flight-LP said:
If the pt. is conscious after Glucagon administration with an acceptable BGL, I'd leave it be. Check it every 5 minutes until arrival, treat if BGL drops again...
Click to expand...


Ditto....... no need to push D50 until the BGL drops
 
Yeah i think you would of been good with just given glucagon 1mg IM...If her sugar level didnt go up with that and u were able to get a IV going then you would go with 50% dextrose ...
 
medic03 said:
Ditto....... no need to push D50 until the BGL drops
Click to expand...


It does not need to be explained any other way.
 
Should I be unconscious, my wife would recommend 1.5mg of Glucagon initial dose, and .5mg 45mins later for treatment. Mine comes in a vial, solid state, with a predrawn syringe of sterile water.

We would only call the local EMS if I were going to code.. Because you can't kill someone who is already dead. :P
 
TTLWHKR said:
..... Because you can't kill someone who is already dead. :P
Click to expand...

lol, you haven't seen some of my students. :)
...j/k
 
The RN was right

trauma1534 said:
I had a run in with an ER nurse this past weekend... we brought in a Hypoglycemic patient, when we picked them up, they were unresponsive with a blood sugar of 51. I want to know what different protocols say about this.

This is what happened.. tell me what you would have done in this situation.

As I said, the patient was unresponsive.. family reports that they have been this way for about 3-4 hours. Then they decided to call 911 (hmmmm wonder why???!!!) We went in got the sugar level, attempted to start an IV for D-50. All we carry on our trucks for IV fluids is Normal Saline. After 2 tries, IV was unsuccessful, so we gave 1mg Glucagon SQ. We then attempted to get another IV, it was successful... before we could get it taped down, he started to come around, moved his arm and pulled the line. Got him loaded in the truck, while enroute, got a line established.. got another Blood Sugar Level of 114. Went ahead and pushed D-50. after 10 min. rechecked sugar, it was now 314.

Got him in the ER, reported to the nurse, turned patient over, and started writing report. Nurse came in and asked why we gave Glucagon and followed it with D-50. We told him that it was our protocol. He said that he had never heard of it. Demanded to see our protocol book... said that the patient's level was now 540.

How many would have done the same thing? Who disagrees and why?
Click to expand...

Why would you give a patient with a "normal" blood glucose level D50?
Whoever wrote your protocol book should take a refresher course! Why would your medical director approve such a protocal?
Now you have made the patient significantly hyperglycemic. Now his treatment will be harder to manage in the ER. Insulin drips, rechecking blood glucose levels, watching the pH..... With the D50 and glucagon onboard your patients glucose levels will continue to rise.
You took a realitively straight forward patient and turned it into a probable hospital admission. I would like to hear why your medical director advocates treating normal blood glucose levels.
 
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