Does BGL Plunge After D50 Administration?

[AnthonyM83]

I had someone tell me that when you give a hypoglycemic D50 via IV it almost immediately skyrockets their Blood Sugar Level, then it starts plunging down....so that when you re-take a sugar a few minutes after D50 admin, you're really getting a decreasing number...it's no longer going up.

I haven't had a diabetic call since I was told this to check the BGL trend myself...but I always thought it was always slowly going up, then slowly down after several minutes (not an immediately spike, then drop).

Any thoughts on this?

[AZCEP]

There is more going on here than a simple answer can give you, but kudos for asking the question.

For a diabetic, the change in blood glucose level (BGL) will be related to the amount and time since their last dose of insulin. It will also depend on the presence of viral/bacterial infections that alter the sensitivity to the insulin and glucose.

For someone that is simply hypoglycemic, it makes sense to manage the underlying cause of the problem. Dextrose solutions will manage the hypoglycemia, but do nothing for the reason for it.

[DirtJerZ]

Carbohydrates are essential for sugar to be metabolized correctly. I also give 100 mg thiamine before D50 administration because this has been proven to prevent kidney damage in diabetics. (I also hear it burns so give it before administration.) I can imagie someones sugar dropping rapidly after d50 administration, but have not seen it happen. If you give carbs you can avoid finding out.

[air.stump]

I think it relies on why the patient is hypoglycemic. I would think that their blood glucose levels would rise rapidly and start to fall immediately if the cause of their hypoglycemia was incorrect insulin dosage; too much.

I thought we gave Thiamine with D50 to help avoid Wernicke's Encephalopathy in thiamine deficient patients, like alcoholics.

[sevenball]

You pull your glucose reading from a capillary source. When you introduce glucose directly into the blood stream, you can measure it immediately (almost). After a few minutes, that sugar gets distributed to where it needs to go. Creb cycle uses it, cells use it, some gets used to replenish the sugar stores, ect... you get the point. That is where you can see your dropoff. There is actually a formula out there that you can use that will help you determine how much D50 you can give to prevent a drop, I just don't know what it is.

[Doczilla]

Carbohydrates are essential for sugar to be metabolized correctly. I also give 100 mg thiamine before D50 administration because this has been proven to prevent kidney damage in diabetics. (I also hear it burns so give it before administration.) I can imagie someones sugar dropping rapidly after d50 administration, but have not seen it happen. If you give carbs you can avoid finding out.

First, sugar is a carbohydrate. I'm not sure what your first sentence means.

Second, while thiamine is an essential vitamin, particularly for folks with impaired glucose metabolism, I have not heard of it preventing renal failure in someone who is acutely hypoglycemic. Thiamine has been given empirically before D50 administration to prevent Wernecke's encephalopathy, which has been seen in anecdotal reports after D50 administration. We have moved away from this practice, instead concentrating on administering the D50 as soon as possible. For chronic alcoholics, they'll get thiamine in the banana bag.

Third, and what I think you're getting at, is the patient should be fed as soon as practical in order to get a load of complex carbohydrate to stabilize the blood sugar. D50 has about 100 calories in it, so not very much. It's enough to get them over the hump, but they'll need a larger load of simple and complex carbohydrates to maintain an appropriate glucose level.

'zilla

[explenture]

100 calories in D50...interesting....so this can be added to patter w/ pt....you've got about 100 calories in you so you need a sandwich etc...

[DirtJerZ]

First, sugar is a carbohydrate. I'm not sure what your first sentence means.

Second, while thiamine is an essential vitamin, particularly for folks with impaired glucose metabolism, I have not heard of it preventing renal failure in someone who is acutely hypoglycemic. Thiamine has been given empirically before D50 administration to prevent Wernecke's encephalopathy, which has been seen in anecdotal reports after D50 administration. We have moved away from this practice, instead concentrating on administering the D50 as soon as possible. For chronic alcoholics, they'll get thiamine in the banana bag.

Third, and what I think you're getting at, is the patient should be fed as soon as practical in order to get a load of complex carbohydrate to stabilize the blood sugar. D50 has about 100 calories in it, so not very much. It's enough to get them over the hump, but they'll need a larger load of simple and complex carbohydrates to maintain an appropriate glucose level.

'zilla

[fireflymedic]

D 50 is a pure simple sugar meant to immediately increase BGL in a short period of time. It must be followed with additional carbohydrates to provide long term maintenance otherwise you will have a scenario similar to what you stated. Thiamine is given basically as a facilitator in absorbtion of glucose to allow the body to process it better in alcoholics as they have liver damage (and remember the liver is where glycogen stores are which convert to glucose). As doczilla stated, that is the basic benefit to thiamine, otherwise, there isn't much benefit to thiamine administration to the average diabetic patient. D 50 does the job of a quick boost the same as gel glucose or orange juice would do, but the patient must follow up with something longer term as a regular meal otherwise their body goes nuts with processing the sugar actually causing them to go hypo again (similar to if they eat something very sugary sometimes they will experience an immediate surge then the body over comepensates causing hypoglycemia later on). Hope this helped.

[AnthonyM83]

So, is the answer no?

I know there's no clear cut answer, but what I was asking is:

Is there a SHARP immediate spike RIGHT after D50 admin followed by slow decline, all within say 15 minutes for blood sugars initially between 30-60, due to insulin miscalculation, as a general TREND?

Or is does it relate to exact situation (even within parameters listed in previous sentence) so much that there is no trend?

Basically, I know initial D50 wears off rapidly and patient needs complex carbs to keep it up, but does it happen SO fast that when you re-take sugar a 5-15 minutes later and it's now 80ish, it's already going down?

I ask because I usually don't see patients crash out again within the hour after arrival at ER post D50 bolus waiting for a room even without getting the complex carbs...so it seems it doesn't happen THAT incredibely fast... You'd think if it went back down to 80 after 15 minutes, patient would be back to 40ish and altered by the time we go to ER.

Does that question make sense?