So I’m an EMT-B and my partner is a Paramedic. Recently we responded to a call for the “Diabetic”. Fire arrived on scene before us and had already done a brief assessment, telling us that the patient was an unresponsive female in her 50’s, was breathing normally on her own, had a strong regular pulse, and had a BGL of 91. My partner did his thing while I set up the stretcher. We moved her into the ambulance and I hooked her up to the monitor while my partner started a line. We could not figure out why she was unresponsive. All her vitals looked fine, EKG was normal, no suspected drug or alcohol use. Family members on scene stated she had type one diabetes and her last known well Time was three hours prior. We did another Blood sugar before leaving the scene and got 106. We transported her to a nearby hospital about 7 minutes away, where the doctor decided they would give D50. A nurse took a blood sugar right before they administered the D50 and got 29! They gave the D50 and the woman woke up and was good as knew. They told us we need to recalibrate our glucometers, and we felt pretty embarrassed. Normally that would make sense but the fire department also got a similar BGL so either both the glucometers were messed up or something else happened. Anyone ever have something similar happen or have any explanations? I’d love to learn from this.
Unresponsive diabetic patient BGL on scene vs. at hospital
- Thread starter Tommy B
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NPO
Forum Deputy Chief
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Well, let's start off with the obvious one first..
Have you calibrated or tested the glucometer since?
Have you calibrated or tested the glucometer since?
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Does your service and the FD share test strips by any chance?
DrParasite
The fire extinguisher is not just for show
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I find it highly suspicious that both your glucometer and the nearest engine's glucometer are both in need to calibration..... at the same time..... when you have a diabetic patient. If they were both found to be in need of calibration, I think that would be enough cause to calibrate every glucometer in the system, because something is not right.
Did you do the self test with the testing liquid at the beginning of your shift? was it normal?
Did you do the self test with the testing liquid at the beginning of your shift? was it normal?
ParamagicFF
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Seems like it would be very unusual for both meters to be out of calibration at the same time, especially since you go on to imply that they are routinely calibrated. Without further information, it does read like an equipment error. I can't think of any conditions where loss of consciousness would precede hypoglycemia, only to be then reversed by fixing the hypoglycemia.
Does your machine need to be calibrated to each new batch of strips?
Does your machine need to be calibrated to each new batch of strips?
E tank
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Just thinking out loud here...Its possible that in brittle diabetics prone to hypoglycemia a symptomatic "relative" hypoglycemia could occur. If the BG was falling fast enough, someone unaccustomed to a plunge to 106 or so could become symptomatic. The time it takes to get to the hospital... the plunge could be at 29.
That's one of the reasons I don't give regular insulin iv to awake patients. Only SC for them because on occasion, someone will get sweaty and dysphoric for a drop from 280 to 200 or less with iv insulin.
FWIW
That's one of the reasons I don't give regular insulin iv to awake patients. Only SC for them because on occasion, someone will get sweaty and dysphoric for a drop from 280 to 200 or less with iv insulin.
FWIW
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Yes. I've seen it, and that was going to be my original response, but the rest of his story didn't fit my explanation.
I once had a patient who's blood sugar was high 60s. Unresponsive, and the story from family sounded like a syncope in the shower. Several things made me feel that this family member probably wasn't good with her medications, was poor, and of lower socioeconomic status. I made the assumption that this meant that the patient probably had a normally elevated BGL and that 68 was low for her. I treated her with D10 and viola! Good as new.
Remember not everyone falls into the "Normal' Range.
My mother's normal blood glucose range was 110-150. Below 85 she would be acting like most people do when they are in the 50's.
Her doctor would not believe her and my dad, I told my dad to treat her like her sugar was lower. she finally was in the office when her blood glucose was 86 and she was unresponsive. Doctor had assistant call 911, my dad gave her decorator's frosting (Oral Glucose made her vomit), she was fine when EMS arrived).
My mother's normal blood glucose range was 110-150. Below 85 she would be acting like most people do when they are in the 50's.
Her doctor would not believe her and my dad, I told my dad to treat her like her sugar was lower. she finally was in the office when her blood glucose was 86 and she was unresponsive. Doctor had assistant call 911, my dad gave her decorator's frosting (Oral Glucose made her vomit), she was fine when EMS arrived).