Glucose Admin Failed to Raise Blood Sugar

[Devin Hunt]

I'm new to the world of EMS and had my second shift on the Ambulance so please forgive me if these are dumb questions, but I haven't been able to find an answer. I work in public health so I have some medical experience, but not in an emergency situation. Anyway, here was the scenario:

A patient presented with low blood sugar and a history of diabetes and lung cancer. She fell and couldn't get back up and her speech was a bit slurred. The first blood glucose reading we had was 20 mg/dL. 15g of oral glucose were administered. The second blood glucose reading was 31 mg/dL. Another 15g of oral glucose was administered. The third blood glucose reading was 25 mg/dL. At that time since we couldn't get her glucose levels up a paramedic was picked up on our way to the hospital. No IV line could be established and Glucagon was administered before we reached the hospital. She stated she didn't eat that day because of nausea and she stated she hadn't administered her insulin that day. She was able to take the glucose with no problem.

I'm curious why the oral glucose didn't work in effectively raising her blood glucose levels? Is there a possible interaction with her lung cancer that may have caused the oral glucose to be ineffective? Are there medications that might interact with oral glucose?

Thanks for your feedback. I'm trying to learn as much as I can to be a better EMT down the road.

 

[luke_31]

The glucose paste that is used will not always raise a patient's blood sugar to normal levels, especially when they are that low. It also takes a couple minutes for the glucose to enter the blood stream, so if you are checking the sugar soon after administration, it's entirely possible for it to still be reading low as the sugar hasn't been processed yet. In your situation you are dealing with a patient who hasn't eaten for a while and is diabetic, it's entirely possible that the body needed that sugar and as soon as it got any, the body immediately burned it up. A patient like this the most important thing is that they eat, we can get their sugar to a normal level with dextrose, but the body requires food for a more stable long term sugar source as dextrose will not last for a long period of time.

 

[CALEMT]

dextrose will not last for a long period of time.

I tend to compare dextrose with a quick fix. It'll solve the problem for a short amount of time, but for the long term eating and checking of your blood sugar are really the best. Most diabetic patients that get dextrose end up AMAing and will make a pb&j or drink orange juice to get them that sugar to sustain them for a while (i.e. The next meal).

Like luke says with oral glucose it'll take some time to get a reading because of how long it takes to absorb the medication through the gums. IV will be quicker but will still have a bit of a delay. It's best to wait a bit, reassess vital signs and check a BGL.

 

[E tank]

Just looking at the patient going from being zombie-like to a normal human being is a good sign too.

 

[Devin Hunt]

Thanks all for your input. We reinforced her need to eat a meal even if she is nauseous from her chemo regimen as the glucose is, as you've stated, a quick fix to keep her sugar from dropping even lower. I'm trying to understand the biological processes that go on so I could better understand why this was playing out out in this manner. I wasn't around for the administration of the first glucose since I was getting a list of her meds at the time, so I'm not sure what the time frame was between administration and recheck of BGL, but I'm assuming they waited the appropriate time. Thanks again!