Category Archives: Hypoglycemia

Question: I’m a recent graduate from the paramedic program and was wondering if I can get some feedback regarding the hypoglycemia treatment. The new protocol that came into play that now includes D10, I was curious what the reasoning was for choosing D10 over D50? Is there anything specific separating the 2 options of treatment?

Question: A couple questions with regards to D10. We have used D10 a few times now to treat hypoglycemia and have noticed some issues. It seems that for anyone with a BLG that is very low (say less than 2.0 for argument sake) the max dose of 10g will not get them over 4.0 mmol/L. Is there plans in the future to increase the dose? Perhaps something like if the patient is < 2.0 mmol/L then a 20g max or 4ml/kg loading dose followed by a 10g or 2ml/kg maintenance dose if necessary?

Second, with regards to Buretrol administration of D10, the process is very slow. Both the setup of the Buretrol and the infusion take quite a bit of time obviously more so if a second dose is required. Is there any reason a 60ml syringe can't be used (draw up and push 60cc and follow up with 40cc) as a push administration instead of the Buretrol? For most situations the slow drip is okay but in the case of an agitated or aggressive patient the quicker option would be nice. I realize the benefits of D10 over D50 in not sky rocketing BGL but the way it is laid out now seems that we have gone too far the other way in not raising BGL enough.

Question: Can we draw up D10 in a 50cc syringe and administer it that way instead of going through the Buretrol?

Question: In a situation where we are unable to get a blood glucose reading from the patient's finger due to patient being combative/handcuffed, are we allowed to get it from the toes of the patient?

Question: If a patient is presenting with signs and symptoms of hypoglycemia (confusion, diaphoresis, pallor, tachycardia, etc.) and you find them with a BG of 4.5mmol/L, but family on scene states their normal BG is over 12mmol/L, and that they are presenting as they typically do when their blood sugar is low, AND you cannot identify from assessment/history any other reason for their current presentation, is it advised to give them oral glucose at this point if they are able to swallow?

Question: Trauma and BGL. Is it imperative, at a traumatic event, when no signs of hypoglycemia where evident (e.g. guy on a bike hit by a car) to do a blood glucose reading even when a decreased LOA is present. Generally, does stressful events such as this not trigger a sympathetic response which would elevate the reading anyway? I understand if someone was acting different prior to such events. If BGL reading is to be done, when would the MAC feel it most appropriate to obtain, immediately or after package and in the truck? Thanks.

Question: Whilst completing my pre-course recertification material, we were asked a question with regards to blood glucose testing. Following administration of med for hypoglycemia, the question asked when next should you do a blood glucose test. I had guessed after 5 min although re-dosing would not be for 10 or 20 min depending on drug used. I guessed wrong apparently.

The other choices would have been:
a) With EVERY vitals post treatment (what about a long off load, we might do 3 or 4 more sets of vitals!)
b) After no improvement (no time noted and they might not show no improvement for a few minutes and sticking them after just two would be unnecessary)
c) Once at the hospital (that would disallow the re-administration of a second dose of treatment.)

Question: What is the Medical Director's direction on doing repeated blood sugars after treatment for hypoglycemia? I recently had a patient who complained of chest pain after a fall. He was a diabetic with a GCS of 14 on initial assessment. His blood sugar was 3.8 and I treated him with oral glucose. He felt better and his GCS became 15. I got a comment back from an auditor who felt I should have done a follow up blood sugar after treating him. I was always taught that it was unnecessary to do a blood glucose if the patient had a GCS of 15. Has there been a change in thinking?

Question: With regards to the administration of D50W. I was just curious if it has ever been to considered for us to titrate this drug for effect. By this I mean, if you are pushing the 10ml of D50 then flushing and repeating this until the entire 50ml is given it is assumed that you will likely notice positive effects of the drug before it is all given. So would we be better off to stop the infusion and re-check a blood sugar at this point to see if we have achieved a blood glucose above 4 or within normal range as opposed to giving the whole dose and pushing their blood sugars usually above 10.

Question: I have noticed a number of paramedics do blood glucose testing based on the hx of an event and not how the patient is presenting at the time of assessment. For example - hx of fainting, period of unresponsiveness, diabetic with N/V, etc. If the patient is not presenting with any of the indicators outlined in the hypoglycemia protocol should we be testing the patient’s blood glucose levels?

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