Pushing D50

[chbare]

Since one of the many actions of glucagon revolves around mobilizing hepatic stores of glycogen, it is reasonable to expect people with significant pathology such as starvation or perhaps liver problems would not benefit much or at all from glucagon.

Take care,

chbare.

[FireMedic65]

Since one of the many actions of glucagon revolves around mobilizing hepatic stores of glycogen, it is reasonable to expect people with significant pathology such as starvation or perhaps liver problems would not benefit much or at all from glucagon.

Take care,

chbare.

Is that what causes Somogyi phenomenon? Or do I need to go back and re-read about that?

[chbare]

Is that what causes Somogyi phenomenon? Or do I need to go back and re-read about that?

I am not quite sure of your question. However the Somogyi effect is more of a rebound hyperglycemia when the body tries to raise blood sugar suddenly. It may occur at night in people who develop hypoglycemia, then wake up hyperglycemic. The hormone mechanisms do involve glucagon release and glycogen utilization however.

Take care,

chbare.

[bigj1130]

I only glanced over the topic so if I am beating the proverbial horse I apologize.

1. If in doubt don't push it... If you only have 10cc Flushes, walk back to the unit and get a bag to hang.

2 If in doubt and you can't even hope for access, Drill them An IO needle can be removed pre-hospital, just like an IV can be removed. I would try my best to convince that person that an ED visit is in order but most Diabetics I have dealt with in the last 10 years are not too keen on going to the hospital after being woke up. Also just because d50 is preloaded as 25Grams, do we necessarilly have to give all 25 grams? Why not just titrate to effect wake them up and give them food, make them a peanut butter sandwich or help them prepare a meal. We are clinicians not just a call and a haul.

3. In regards to ED docs altering a Diabetic's med doses... If that is the case in your areas, you are a much luckier person than I am. Our ED docs will draw essential labs and tell the patient to follow up with their PCP. I know that is the case in other areas as well. What is stopping us from helping that patient get an appointment with their endocrinologist or PCP who has all of their records right there and has been the one altering those dosages for a lot longer than an ED doc who just met them.

Please do not take this as trying to get a refusal on every diabetic out there. I will try as much as I can spending untold amounts of time on scene to convince somebody to go, but I am not going to purposely load them in the unit wake them up during transport and just drop them off at the hospital because it just makes my job easier. If my patients do not want to go to the hospital I do everything I can to make sure their Blood Glucose Levels are maintained prior to me leaving and that they have appointments with their doctor or have at least spoke to their doctor before I will get out the refusal form.

[crotchitymedic1986]

If you have to use an IO, you have poor IV skills.

[chbare]

If you have to use an IO, you have poor IV skills.

I do not suppose you have a good peer reviewed study to back up your claim?

Take care,

chbare.

[Breck]

Why do you feel its necessary to transport someone who just missed a meal? Alot of diabetics are negligent and if they sign the refusal after you gave them after care instructions then its on them, not you. I rarely transport diabetics unless they have another sign or symptom that is deemed unstable.

[ERDoc]

Why do you feel its necessary to transport someone who just missed a meal? Alot of diabetics are negligent and if they sign the refusal after you gave them after care instructions then its on them, not you. I rarely transport diabetics unless they have another sign or symptom that is deemed unstable.

So, under what conditions do you transport a diabetic? What S&S are you referring to?

[HERBIE1]

If you have to use an IO, you have poor IV skills.

Does that also apply to a doc that needs to do a cut down on a patient with poor peripheral veins?

Another point on D50, how many patients do we push a full amp (25g) of D50 and get a refusal for transport when we should be talking our patient into going to the ER to be checked out. The number of times I have heard a medic say "well your sugar was just a little low, you don't need to go to the hospital just sign here" when dealing with a patient they found altered or unresponsive makes me sick. If the patient is to altered to eat something then they need to be checked by a doctor even if the only reason their sugar is low is something as simple as they did not eat dinner last night. I work under the

you call we haul theroy, I would much rather get called in to a supervisor's office to explain someone calling to complain about me trying to talk them into going to the ER then having to go back and work a full arrest on a patient I talked out of going to the hospital. Just my two cents on D50 in EMS

So if a person provided you with a perfectly rational reason for why their glucose level dropped(ie they fell asleep early because they were tired and missed their dinner or late night snack), you simply dismiss what they are telling you? Remember, when this person's levels return to normal, they are fully alert, oriented, and competent to sign a release if they so choose,provided there are no other factors involved. You give them options, explain potential problems, advise them to eat, and let THEM make the decision.

I'm more than happy to take someone, but I also don't feel compelled to strong arm someone- especially a life long diabetic- to be transported. They KNOW what to do and have heard it all before. The most logical person they need to see is their endocrinologist or GP- they are most familiar with their patient, their diet, any compliance issues, and any trends the patient has with the management of their disease.

In the case of a new diabetic, someone who is very brittle, or I suspect is not telling us the whole story, I always urge them to allow transport and do my best to scare them into it, if necessary.

[Mateo_1387]

In the case of a new diabetic, someone who is very brittle, or I suspect is not telling us the whole story, I always urge them to allow transport and do my best to scare them into it, if necessary.

Herbie, you were sounding decent until you started spewing that. You should not scare people into completing your agenda. That my friend is called coercion.

Read about it here and here.