NYMedic828
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Moral of the story - its pretty hard to hurt somebody with the equivalent of a few jolly ranchers.
When to not use glucose
- Thread starter golf
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I've had patients with a sugar level in the low 600's, and they were totally alert, as if nothing was wrong. :wacko:
Anjel
Forum Angel
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Our glucometers go till 600 and then read high. We had a "high" reading and the lady was just complaining of a headache lol
NYMedic828
Forum Deputy Chief
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Read my long post...
I explained it...
I explained it...
TraprMike
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glucagon for the win!!
mycrofft
Still crazy but elsewhere
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Wilderness first aid
1. The amount of sugar you can give in a Glutose tube is like 15 grams? If hyperglycemic, this will not be enough to worsen it, and can help if hypo.
But..."wilderness"....this like glucagon will hit and then run (if the pt is hypoglycemic). If a hypo pt rouses, get some real live food into them.
2. How much sugar is the oral mucosa adapted to absorb into the bloodstream? One study shows that dextro sugar is absorbed better than levo ones http://onlinelibrary.wiley.com/doi/10.1211/0022357021778402/abstract
but their study is in vitro...they didn't just put sugar in a pt mouth then measure serum glucose, they used instruments and a petrie dish so to speak. Doesn't indicate if the transport is significant.
If you put sugar in the mouth your salivate. If you salivate you swallow (get it orally) or drool it out (don't get it in at all). If you drool and don't drool it out, you can aspirate. The "don't dose obtunded pts" rule still makes sense, especially in the wilderness.
1. The amount of sugar you can give in a Glutose tube is like 15 grams? If hyperglycemic, this will not be enough to worsen it, and can help if hypo.
But..."wilderness"....this like glucagon will hit and then run (if the pt is hypoglycemic). If a hypo pt rouses, get some real live food into them.
2. How much sugar is the oral mucosa adapted to absorb into the bloodstream? One study shows that dextro sugar is absorbed better than levo ones http://onlinelibrary.wiley.com/doi/10.1211/0022357021778402/abstract
but their study is in vitro...they didn't just put sugar in a pt mouth then measure serum glucose, they used instruments and a petrie dish so to speak. Doesn't indicate if the transport is significant.
If you put sugar in the mouth your salivate. If you salivate you swallow (get it orally) or drool it out (don't get it in at all). If you drool and don't drool it out, you can aspirate. The "don't dose obtunded pts" rule still makes sense, especially in the wilderness.
Chris07
Competent in Incompetence
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In a backcountry setting, if you are unsure about whether or not a person has hypoglycemia or hyperglycemia, it is best to give them sugar. Hypoglycemia kills much faster than hyperglycemia, and hypoglycemia is really the only thing we can treat in the backcountry. Hyperglycemia, cannot and should not be treated in the backcountry.
Will giving sugar to a hyperglycemia make their sugar higher? Yes, but not by much. Will withholding sugar from a hypoglycemic hurt them? Yes, it can even kill them. In general, unless you KNOW the person is suffering from Hyperglycemia, sugar should be given.
...oh and for the love of God, don't give a hyperglycemic insulin "to lower their sugar". It's risky and can crash their sugar levels. Hyperglycemics are best given controlled doses of insulin in a clinical setting, not a half-syringe full under a tree in the Appalachian mountains.
Will giving sugar to a hyperglycemia make their sugar higher? Yes, but not by much. Will withholding sugar from a hypoglycemic hurt them? Yes, it can even kill them. In general, unless you KNOW the person is suffering from Hyperglycemia, sugar should be given.
...oh and for the love of God, don't give a hyperglycemic insulin "to lower their sugar". It's risky and can crash their sugar levels. Hyperglycemics are best given controlled doses of insulin in a clinical setting, not a half-syringe full under a tree in the Appalachian mountains.
mycrofft
Still crazy but elsewhere
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Chris, having create unstable diabetics for six years I say RIGHT ON. Start seesawing insulin and glucose and a positive feedback cycle quickly develops, then huge swings, or apparent periods of stability which rapidly dissolve.
1. Give sugar if pt can manage airway and swallow.
2. Get them out to help.
Oh, and entertain the thought that maybe there is something else wrong instead of/as well as glucose imbalance. Keep evaluating, don't get all target fixated.
1. Give sugar if pt can manage airway and swallow.
2. Get them out to help.
Oh, and entertain the thought that maybe there is something else wrong instead of/as well as glucose imbalance. Keep evaluating, don't get all target fixated.