Early on when I was starting insulin I had some learning curves in the area of low blood sugars (hypoglycemia). I’d been given the diabetic teaching about what to do, and I’d been an RN for 22 years by the time I started on insulin. Generally, I did well at home getting my blood sugars back up with regular soda or glucose tablets/gel. One day, nothing was working. I had to call 911 when I hit 37mg/dl, and couldn’t get it to go up no matter what I did.
The paramedics got there, and I was still in the upper 30s. They gave me more gel, and got an IV going in the ambulance. I was still conscious and able to talk to them, but I felt BAD. They radioed ahead that I was coming, and unfortunately I had to go to the closest ER which was notoriously horrible. En route, they gave me an amp of IV dextrose (D50). I had my purse with me that had my backup glucose meter and change for the vending machines. That proved to be incredibly important.
I was given another amp of D50 , and my blood sugar went up to 128mg/dl. The nurse (who rarely made eye contact, and just muttered as if I were the most ridiculous thing she’d seen come through the door all day) said she’d called a cab for me; they’d be there in 45 minutes. I knew that I had to have some source of protein and/or fat to keep my blood sugar from tanking again. The basic information for hypoglycemia says that a snack is needed if the next meal is more than 30 minutes away. Evidently the EMERGENCY room people didn’t know that basic information. Straight glucose will spike and then drop. That’s just how it works. I was sent to the lobby to wait.
Within about 10 minutes, I could feel my blood sugar drop. I checked it, and it was in the 70s. I got a Coke and some Starburst candy from the vending machines. It wasn’t helping. I got some peanuts to help my blood sugar stay put. The peanuts didn’t help. My blood sugar was in the 50s by then. I went to the triage desk and told them what was going on. I was told I’d already been seen, and a nurse might be able to get out and check on me in a while. Really? I’d been brought in by ambulance for hypoglycemia, I was bottoming out again, and I was thrown to the whim of some nurse who might get to me? I was safer in the cab.
I managed to stay in the 50s until the cab got there, and got home where I could work on evening out my blood sugar on my own. The ER obviously wasn’t going to complete the process with protein/fat sources. I got some peanut butter, and that helped. Now when I go anywhere I take glucose tablets or gel and portable peanut butter. I make sure my blood sugar is in a range that lets me function before I eat the peanut butter, or it will slow down the glucose’s ability to work. The duration of action of D50 is dependent on the degree of hypoglycemia (and the symptoms of low blood sugar are different for everyone at different levels of hypoglycemia). One person can be unconscious at 40 mg/dl, while someone else can be talking at 30 mg/dl…both are in severe hypoglycemia and need immediate treatment.
I learned a lesson about the emergency personnel’s lack of comprehension on how fully to deal with hypoglycemia. I have to take care of myself even IN the emergency department at a hospital. At least the shoddy one. I can’t depend on anyone to help me; I have to be prepared and advocate for myself.