abckidsmom
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Or possibly an overdose of metformin or some other oral hypoglycemic.
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- Thread starter Swimfinn
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no her blood sugar went up 91. it fell back down after the ten mins it took to get her packaged and into the truck
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Anjel
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Ohhhh ok. Ya too much insulin.
That's definately suspicious of some extrinsic factor tanking BGL.
Although, as with anyone, as soon as it's humanly possible you try to get a more complex form of sugar in their system. In this case, if she didn't resume mentation, that's not possible.
I've seen firefighters head into their kitchen, peruse through their fridge, and cook them a meal. Truly heartwarming. And firefighters are great cooks.
Although, as with anyone, as soon as it's humanly possible you try to get a more complex form of sugar in their system. In this case, if she didn't resume mentation, that's not possible.
I've seen firefighters head into their kitchen, peruse through their fridge, and cook them a meal. Truly heartwarming. And firefighters are great cooks.
abckidsmom
Dances with Patients
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That's definately suspicious of some extrinsic factor tanking BGL.
Although, as with anyone, as soon as it's humanly possible you try to get a more complex form of sugar in their system. In this case, if she didn't resume mentation, that's not possible.
I've seen firefighters head into their kitchen, peruse through their fridge, and cook them a meal. Truly heartwarming. And firefighters are great cooks.
We have an hour transport time to the hospital. I've cooked plenty of meals for people. If they aren't sick, can point to a clear reason for the low, and are feeling better, it's worth it.
Sometimes these patients can be tricky and you really need to look at their meds and some other factors.
What diabetic meds is she on? Sulfonylurea, metformin, insulin (short or long acting), etc...
Has she missed meals?
Does she have renal insufficiency?
Metformin has low incidence of hypoglycemia and probably would not be the culprit. Certainly an overdose can cause other serious issues but in someone taking as directed it has low risk of hypoglycemic events.
Usually we see an elderly person on a sulfonylurea (Ex: glipizide) with maybe some underlying renal insufficiency who continues to take the med and stops eating, OR develops worsening renal failure and doesn't clear the drug. Sulfonylureas are the ones that directly stimulate insulin release and are notorious for causing hypoglycemia. Combine a long acting Sulfonylurea with some renal failure and you can have refractory hypoglycemia that can last a day or so necessitating putting them on a D5/D10 drip until the drug is cleared. They'll improve after that amp of D50 you give but will continue to crash if not given some continued support. Same goes with a long acting insulting such as levemir, they can get mixed up and give themselves 100units instead of 10 and the same applies.
What diabetic meds is she on? Sulfonylurea, metformin, insulin (short or long acting), etc...
Has she missed meals?
Does she have renal insufficiency?
Metformin has low incidence of hypoglycemia and probably would not be the culprit. Certainly an overdose can cause other serious issues but in someone taking as directed it has low risk of hypoglycemic events.
Usually we see an elderly person on a sulfonylurea (Ex: glipizide) with maybe some underlying renal insufficiency who continues to take the med and stops eating, OR develops worsening renal failure and doesn't clear the drug. Sulfonylureas are the ones that directly stimulate insulin release and are notorious for causing hypoglycemia. Combine a long acting Sulfonylurea with some renal failure and you can have refractory hypoglycemia that can last a day or so necessitating putting them on a D5/D10 drip until the drug is cleared. They'll improve after that amp of D50 you give but will continue to crash if not given some continued support. Same goes with a long acting insulting such as levemir, they can get mixed up and give themselves 100units instead of 10 and the same applies.
Have not
well she claimed to have been on the floor for 3 days at one point. but im not so sure about that for many reasons. first of all she was altered. second if her bloodsugar was low cause she missed meals, why did her glucose drop again below 50 after an amp of D-50? it had to be an insulin overdose.
and again we really werent able to obtain much of any useful information from her. if we asked her how long she had been on the floor it would vary from 3 days to 6 hours. also, anytime we tried to ask her something all she would say is "im sorry im sorry"
her voice was hoarse like she was possibly a smoker?
if she was septic could that explain why her blood sugar was unstable after the first amp of d-50?
her voice was hoarse like she was possibly a smoker?
if she was septic could that explain why her blood sugar was unstable after the first amp of d-50?
Aidey
Community Leader Emeritus
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Or liver failure.
Why no medications? Were you unable to search the obvious spots to see what she takes?
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Time out.
Since when can't we give glucagon to kids or alkys? I agree with your science but it is still approved for use in both situations.
With that said, just because we can give it doesn't mean it's going to work.
Food for thought, and please don't shoot me for quoting a protocol but
<20 kg and unable to obtain IV access glucagon 0.5 mg IM
>20 kg and unable to obtain IV access glucagon 1.0 mg IM
With a chronic ETOH patient they'd be getting 100 mg thiamine IM as well.
I would love to be allowed to give it IN but who knows if that will ever happen.
abckidsmom
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It's worth a try but it's not going to work. I try it when obtaining IV access is not happening with the quickness.
Aidey
Community Leader Emeritus
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You can always use it, it just may not have much of an affect. It is also highly dependent on the patient and their overall health level. The banana yellow 90lb 5'10'' alcoholic is probably not going to respond. A pink 180lb 5'10'' alcoholic probably will.
See my above post
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Just once I would like to use my OEMS required hammer and large flathead screwdriver!
Even with healthy individuals, don't let glucagon give you a false sense of security. Again, best case scenario is let them stop seizing from hypoglycemia so you can get a line.
Part of the "insulin shock" response is catecholamine release. That's why it got that nickname, thus the symptoms that go with it. Part of that is the release of glucagon, and the conversion of non-carbohydrate substances into energy. [Gluconeogenesis].
How many hemhorragic shock patients are hypoglycemic?
When someone reaches the point of obtundation, and usually by the time you get to them, those initial mechanisms have failed to some extent. So even in a healthy liver, you're pretty much scraping the bottom of the barrel, and giving it that last "umph" to buy literally minutes.
The best I've seen is them going from U on AVPU to P.
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And this is why I bring things up. Because ya'll teach me the stuff school never did.