Does BGL Plunge After D50 Administration?

[steve_emt_68]

Glucagon has the effect of an immediate increase in BGL that will fall off without a carbohydrate. Glucagon releases glucose stores from the liver and is meant to only be administered once in a 24 hour period. I was once called to a nursing home for a bruetal diabetic who was yo yoing all night. Upon our exam and interview, the nursing staff stated that they had administered Glucagon at least 3 times during the night but the patient couldn't maintain an adequate blood glucose reading. My partner and I took a BGL reading which was low, started an IV and administered D50. Patient alert and oriented. We transported to hospital for direct admit. Found out later that the nursing home staff called our Medical Director to complain that we took too long on-scene and checked his BGL and started an IV when they had told us his BGL was low. We should have just transported.

Turns out, nursing staff never feed the patient after Glucagon so he would drop off and since his liver's supply of glucose had been depleated he wouldn't maintain his LOC.

When I pointed out to the Doc that the patient was never feed all was ok and we did the right thing.

As far as the Thiamen goes, we took it off the truck once we found out that you actually have up to 24 hours to administer it to a patient after D50. We just made it a point to inform nursing staff that we had not administered any Thiamen. We didn't have any arguements with any of the Medical Staff for not carrying it on the truck.

[AZCEP]

When were we talking about glucagon?

The issue at hand is related to post administration of D50, and has nothing to do with glucagon or the glycogen stores of the liver.

The best answer that we could give you Anthony is that it depends. I've had it happen to myself personally, and it isn't terribly enjoyable. I'd suggest using your best clinical judgement instead of hearsay, and making your decision based on what presents.

[fireflymedic]

Anthony - how sharply the decline happens after D 50 administration really depends on a few things. First is it just a simple they didn't eat and it went low or did they take their insulin and not eat? If they have insulin working against the D 50, you may see a sharp spike with BGL up to 300, but then drop dramatically within 10-15 minutes afterwards. If they just haven't eaten, it seems the drop occurs much more slowly. Also, are they on oral diabetic meds which work with the little insulin their body already produces? If so, you give the D 50, their body processes that like it would food producing insulin and utilizing the medication as well to supplement their existing insulin. If you have someone on both, you will definitely see the upward spike, then a significant drop quickly. So to answer your question, yes and no, it just depends on the surrounding circumstances.

[AnthonyM83]

Thanks.

(And hey, maybe my friend was confused and talking about glucagon admin when he told me that "fact")

[Doczilla]

Glucagon takes a significant amount of time (45 min) to raise the BGL, and depends on adequate glycogen stores to begin with. It will maintain BGL levels longer than just D50, which can get metabolized very quickly after administration. Don't use this as a reason to give all hypoglycemics glucagon. It's expensive and carries significant risk. Standard of care is still D50 followed by a high-carbohydrate meal.

Patients who have taken insulin or oral antihypoglycemics may have a BGL drop after administration of the D50. Folks with sepsis may also metabolize the glucose quickly. This is why it is very important to STAY with the patient and watch them eat and ALWAYS recheck the BGL before you get that refusal signed.

Patients who are on oral agents only or long acting insulin (Lantus) or who take an OD (intentional or accidental) of oral agents must be taken to the ER and are frequently admitted. Always transport these patients. I have documented drops in BGL on these folks 6 and 8 hours after they took the meds, despite being fed and appearing fine upon initial assessment. I don't screw with these folks any more, and rarely get any push back from the admitting services for it.

'zilla

Edited for clarification: Glycogen stores.