Hypoglycemia

[SEPara]

With a diabetic type 1 patient on an insulin pump, who presents with a BM <4mml. What is the correct treatment?

I ask because recently I know of two cases where this has happened, none of the crews have come across it before and none were 100% sure of the right course of treatment, this in turn has caused a bit of a debate.

your thoughts please?

[spenac]

With a diabetic type 1 patient on an insulin pump, who presents with a BM <4mml. What is the correct treatment?

I ask because recently I know of two cases where this has happened, none of the crews have come across it before and none were 100% sure of the right course of treatment, this in turn has caused a bit of a debate.

your thoughts please?

He presents with a bowel movement ( BM ), hows that a problem? Or is BM something different there? Please remember to spell out so we don't get confused. Thank you.

[Code 8 Paramedic]

yeah if you could decode BM<4mml... cuz that doesnt mean anything to me. Are you refering to his blood gulcose level?

[AZCEP]

First thing to do is turn the pump off. Just like the patient with a morphine pump that stops breathing, if you treat the symptom without treating the problem, you will get little to no result.

Assuming the patient is symptomatic due to the hypoglycemia, treat accordingly. D10 to D50 and watch their blood glucose level. You can reduce the amount of insulin that is being administered, but this is usually reserved for the patient/family to handle when they are able to.

I will agree with my American peers, and recommend not using abbreviations. Too many variations to be sure you are getting the information you seek.

[ccmedoc]

yeah if you could decode BM<4mml... cuz that doesnt mean anything to me. Are you refering to his blood gulcose level?

1 mmol/L is approximately 18 mg/dl for this purpose.

With a diabetic type 1 patient on an insulin pump, who presents with a BM <4mml. What is the correct treatment?

I ask because recently I know of two cases where this has happened, none of the crews have come across it before and none were 100% sure of the right course of treatment, this in turn has caused a bit of a debate.

your thoughts please?

By my calc, this appears to be <72 mg/dl. As normal values are in the 70 mg/dl to 110 mg/dl (depending on institution) not many people in my experience are symptomatic at this level, but if you believe the indication is they are, then turn off the pump and treat accordingly. Just as AZCEP indicated. Very rapid drops could, in theory, cause a patient to present as hypoglycemic. I guess the next question should be how far below 4 mmol/L is the patient??

[itku2er]

What was the blood sugar level? I would need more details other than what you have given but I am all about details though.

I agree with AZ you gotta turn the pump off before you treat.

Long term treatment the MD will have to decide that one.

terr

[asrnj77]

Figured I'd throw my 2 cents in here...as a wearer of a pump I know that it works in a basal/bolus mode. The basal mode is preset to your preferred settings - say maybe .9 units per hour delivered in a small drop maybe every three minutes. When preparing to eat you give an appropriate bolus - many pumps have a safety feature that won't let you give more than 16 units at a time. So perhaps it is possible that the pump has malfunctioned and is continually pushing insulin (never had this happen) and you would need to end/cancel/disconnect. But the minute amount of basal insulin that they are receiving while you are working on them shouldn't be too much of a factor.

If indeed the conversion works out to a BG of 72 then I think there is something else going on besides an insulin reaction. In my younger pre-pump days I could be rocking and rolling on a BG of 40 and few would be the wiser (although I would then eat something so they would continue not being the wiser) Point being I have never ever seen or heard of a diabetic having a severe reaction at 72. I would evaluate the patient - start a line - I guess you can give the dextrose to rule it out but would certainly be thinking something else is wrong especially if LOC. Just my humble opinion

[AZCEP]

As an insulin dependent diabetic, you should recognize that no two individuals will present the same. I too, am a type I diabetic. My normal BGL is 64 mg/dL, and it can drop into the teens with no significant loss of function. How this has anything to do with the question at hand is escaping me. :roll:

No matter what his current BGL is, if he presents as hypoglycemic, treat it. The patient's body becomes reliant on a given level of sugar. Once that level drops below the norm, they will present as there isn't enough of it.

If they are hypoglycemic, the last thing you want to deal with is the continuous infusion of any insulin. Even the low basal rate will give them more than they need. Turn off the pump, and give the dextrose.

[spenac]

I've got a frequent caller that if drops below blood glucose level of 200 crashes. Treat the patient, screw the machines.

[plank27]

would procedure not come into it now with jrcalc that this should be a referral to a receiving G.P to be on hand to advise you of what to do?