BG and protein

[MEDwyerIC]

Question?

As a newer medic I have always been told that after giving D50 25gms to a pt with low BG i.e 65 or lower do we suggest protein( peanut butter sandwhich) intake. I am having a hard time finding accurate info online. If anyone could assit me that would be great thanks.

[DwayneEMTP]

I'm not completly clear on your question...

Are you asking if that is good advice? It is.

Or are you asking why that advice is given? The glucose that you give will quickly be metabolized and they will be calling you back for the same issue soon. If the patient is not being transported, they should be advised to eat something with some protein, which takes the body longer to break down into glucose. You can think of the protein as 'time release' glucose.

This is bad advice to give to someone that doesn't have anyone to care for them, or if that care is unreliable as not eating properly is what got them here in the first place. Assuming they will suddenly begin to do so when you're gone is not a good bet. Transport is much better.

Advising them to eat protein is good. Waiting until you see them eat the protein will keep you from running on the same person again in a few hours.

Others will most likely give more thorough answers, but that's it in a nutshell.

Dwayne

[JPINFV]

Peanut butter sandwich: A biochemical prospective

The bread of the sandwich contains carbohydrates (sugar) and are broken down and manipulated until they reach a glycolytic intermediate. At this stage, they can either be used to produce ATP (glycolysis) or glucose (gluconeogenesis) depending on the bodies needs. The end stage of glycolysis is pyruvate. Again, depending on the bodies needs and organ type, pyruvate (after being changed to an intermediate) can either be transported back to the liver for gluconeogenesis, or converted to acetyl-CoA, which can be used for multiple things including fatty acid synthesis and ATP production (TCA/Krebs/Citric Acid cycle). Once a glycolytic intermediate is converted to acetyl CoA, it loses its ability to be converted back to glucose.

The protein found in the peanut butter is handled differently, but has the same end product. Protein is broken down into individual amino acids prior to absorption. Once absorbed, amino acids are either used for producing proteins or broken down. Unlike glycose (glycogen, fat [glycerol backbone) and acetyl CoA (fat), amino acids can not be stored in the body. Depending on the type of amino acid, it can either be broken down into a glycolytic intermediate (can be used for gluconeogenesis, called a glycolytic amino acid), can be made into a TCA cycle intermediate (called a ketogenic amino acid and only includes leucine and lysine), or can be made into both (example phenylalanine/tyrosine gives off two products, one in each category).

[captainstandup]

As elementary as it may seem, that is giving the patient advice on eating protein, in reality the patient would be better served by a complete workup in the ER and a really specific assessment of their health from an endocrinology perspective.

Even the best equipped pre-hospital providers should, in my opinion, not be giving nutritional advice to a diabetic patient. Lab studies including fasting blood glucose and later on an A1-C would be a great addition to this discussion. You didn't mention whether this was in treatment of a known diabetic or not, furthermore I've never seen a symptomatic patient with a BG of 65, most are much lower.

If this patient, hypothetical or real, is not a known diabetic, they simply must be transferred to the hospital. There is a myriad of conditions other than diabetes that can result in hypoglycemia. Hypoglycemia may actually be a "symptom" rather than a condition, as it were, and must be investigated by folks such as JPINFV who understand the krebs cycle and associated processes.

Most physicians will, after a great deal of lab work and fasting / non-fasting studies either consult with or refer a diabetic patient to a registered dietician for nutritional advice.

[MEDwyerIC]

thanks for the responses.

[gymratt]

Just wanted to say that in our EMS system we are not allowed to administer D50 and not transport. All administration of D50 must be done enroute to the hospital as our med control docs view this as treating a patient and releasing which we are not allowed to do when we apply meds to the treatment. As far as the actual question I feel it has been answered quite correctly in prior posts.