Two questions about diabetes & hypoglycemia

In My Humble Opinion
1

I really should know the answer to both, but I don’t. This is half poll, half factual question; I didn’t want to start two threads on closely-related topics in one day.

First the poll: For those of you who from time to time experience hypoglycemia, how do you feel afterwards? I’m talking really bad episodes, with blood sugar levels under 50 or 60. On the occasions in which my glucose has gone that low, I always feel achy for the rest of the day even after I get out of the danger zone.

And now the factual question: If a person’s blood glucose goes so far down as to require medical treatment, how likely is it they’ll administer sugar intravenously? What else might be done?

Thanks in advance.

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2

IV glucose is not that likely to be used, although it can be (and I’ve used it on patients in the past). Oral glucose would be first line, with an injection of glucagon being considered next, for most cases.

3

In our rescue squad, the order of preference (declining) is:

  • oral glucose, which can only be administered to conscious patients;

  • IV dextrose (D50), which can only be administered via a free-flowing IV line;

  • glucagon IM. If the patient is malnourished or an active alcoholic, glucagon won’t work.

I’ve done oral glucose many times for a patient, seen glucagon twice, and never for D50.

========

I’ve crashed twice, and self-rescued both times. Once the sugar hit and the shaking stopped, I was fine.

4

No discomfort afterwards whatsoever, or no discomfort you could not attribute to another cause?

5

A good rule of thumb in medicine is that if the pt has altered mental status they’ve moved from the compensated to the uncompensated range of the disease. Heat exhuastion vs heat stroke-altered, mild hypothermia vs severe hypothermia-altered. The central nervous system is pretty much sugar only, so if the pt is altered they need glucose quickly. Oral sugars are fine if the pt isn’t at risk for aspiration, and is lucid enough to consume them.

So, IV sugar, assuming you can get an IV, isn’t so much about the number as the mental status. If they’re willing and able to drink some sugar water, cool, if not then the spike.

It’s a nice instant gratification gig for us, watching their brains come back online like you’re turning up the dimmer switch on a light.

6

It’s been a few years, so no discomfort that I remember. I think I got sleepy, but the biggie happened on a Sunday, a day that I normally nap anyway.

Depending on how hard you shake, I could understand sore muscles.

7

Lowest I’ve been is 67 one morning, for no apparent reason, and I didn’t feel any different at all. I used it as an excuse to eat a carb-o-licious breakfast (first orange juice in 2 months!) and promptly went up to 186 for the rest of the day.

8

Rather than start a new thread, I’m piggybacking another diabetes question. It’s sorta related, since Skald asked about body aches after a hypoglycemic episode.

What OTC pain reliever is OK for diabetics? I’ve heard that a diabetic should avoid both ibuprofen and acetaminophen. That leaves aspirin, which is hard on the stomach and (so I’ve heard) should be avoided if you also have high blood pressure.

9

Qadgop and VunderBob both posted while I was composing my reply and brewing a cup of coffee, soooo

Not to be argumentative, but in my niche we use plenty of IV D50, both in the ER and pre-hospital. Far more often than glucagon, which is pretty much only used if you can’t get IV access (or you have a beta blocker OD). Of course, my data set is skewed to the severe side.

10

My doc told me ibuprofen is fine. Why should it be avoided?

Very curious, as I take a lot of ibuprofen. Doc has told me 9-12 a day are fine (I don’t take that every day, but I do have some sort of bursitisy stuff in my shoulder that occasionally ails me, and I take ibuprofen to help with muscle aches & pains that come from running/snowshoeing/skiing/biking).

11

What I reported is my experience as a crewmember EMT-B. I can only give the oral glucose; D50 is preferred because it’s cheaper than glucagon plus it doesn’t leave the body depleted of glucogen. Just the way the calls have rolled, I’ve never seen D50 used.

12

The low blood sugar episodes scare me. After, I feel OK, but I tend to really overeat. Like I’m overcompensating or something.

13

I think because of the high blood pressure.

(I tell him to ask his doctor about what he should take but he always forgets.)

14

Ibuprofen is fine for both our diabetics, both type 1 and type 2. My hubby hasn’t had a low episode, but our daughter has: she hit 34 once. I gave her glucose tabs. She felt kind of queasy as her blood glucose came back up, to the point of almost losing her lunch once. But once it was back up to normal, she was fine.

15

Ah! That’s one thing I don’t have!

But Mr. Athena does, and he takes ibuprofen. Do we need to worry? He’s on… um… Diovan.

16

I’ve been given oral glucose, which got me back into the normal range. Afterward, my head felt kind of “floaty” for the rest of the day, and I generally felt like crap. I wanted to sleep, I was mildly nauseated, and the last thing I wanted to do was eat. I’ve had a few hypoglycemic episodes like that, and I can pretty much count on feeling wrecked until the next morning.

17

Ibuprofen should be okay in most diabetics (and most others, for that matter) unless there’s a history of GI bleeding or chronic kidney disease.

18

I’ve had blood sugar down into the 30s a couple of times, but even the 60s is pretty bad. I get very light-headed and shaky and can’t concentrate. But the main thing is hunger. Obviously at first I crave anything sweet. But even once my glucose level rises to normal, I’m still hungry the rest of the day, no matter how much I eat. And at some point I just have to lie down and take a nap.