Ever seen super delayed reaction to Glucose?

mrhunt

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So! Get on scene for diabetic call, dude is GCS 6, Cool, pale and clammy. Wife is right there and says "he's a diabetic, checked his sugar and it was 25"

boom! super easy, lets wake this guy up! Start a line, give a 250ml bolus of D10 on scene and im thinking this dude will wake right up and say "what happened?! oh no, sorry guys!" just like every other diabetic call ive every had. I tell fire, Nah, were gonna fix him RIGHT HERE! he's too big and sweaty to carry out. He's gonna WALK to the gurney in less than 5 minutes.

So 18G L-AC, slam in some sugar. He's a bit hypoxic with snoring respiration's and fix it easily with an NPA & NRB @ 15lpm and he goes right up to 98%. Check a sugar after bolus and it's now 120mg/dl..........aaaaaaaaaaannnnnddddd............... Nothing. No response whatsoever. So Push 2mg Narcan. Nothing. No response at all.

Well ****! Lets Get going ! Im out of options.
i start thinking this guy has a brain bleed, He's postictal (there was incontinence noted) and is now just status but never saw or reported of any seizure activity or history. SO whatever this is, i cant fix it and lets just use some fancy woo woo lights and drive fast.


Get to hospital and they give 2 amps of D50, Sugar goes to over 200mg/dl now. and Nothing. He start's moving a bit more but really thats it.
I go back later and the dr says he was simply just hypoglycemic and it took his sugar to get to close to 300mg/dl in order to become GCS15 and Even THEN, it was about 15 minutes or more.

Everything else unremarkable.
This was just a crazy interesting call to me. Ive seen diabetics who are GCS15 with sugars of 30 and are CHILLING ........ but needing your levels at close to 300 so that your not damned comatose!??!
 

E tank

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It happens...People that don't control their sugar can walk around high 200's-300's all of the time. Chronically poor glycemic control is a thing. It's why A1c is such an important index.
 

Carlos Danger

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In someone who is super insulin resistant, sure. It's basically the same mechanism as DKA in a type 1 diabetic, they can have a BGS of 800 and be in a coma.
 
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mrhunt

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It happens...People that don't control their sugar can walk around high 200's-300's all of the time. Chronically poor glycemic control is a thing. It's why A1c is such an important index.
I get that people are chronically in the 200's to 300's, I see it all the time.

But i never realized that could be someones MINIMUM level to function at. Thats my whole point.
Was just educational for me and a cool call i thought.
 

johnrsemt

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Just remember people are different: there is no such thing as a normal diabetic.
My mom's normal range was 120-160. She would get confused and diaphoretic at 94 or less and be unconscious at 80. Confused the hell out of a few ED doc's and a couple of paramedics, and her doctors.
 

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