Very low blood sugar

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

Nater44

Senior Member
7+ Year Member
15+ Year Member
20+ Year Member
Joined
May 22, 2003
Messages
322
Reaction score
0
I'm not and er doc and currently enduring the med school application process...but I work as a tech in an ED. We had a lady that was rail thin come in the other night suffering from an eating disorder.

Another tech took her blood suger and said it was 3

All you er docs out there, is that possible? Wouldn't she be in a coma? I must have heard it wrong.

Members don't see this ad.
 
to the best of my knowledge, anything below a 20 mg/dl of glucose in the blood can put you in a coma. The finger tip blood glucose test used in the ED has SOME degree of error attached to it, and I guess the more on the extremes you are, chances are, it'll give a false reading... meaning, a very low or a very high actual blood glucose level would not be accurately read by the device. But it would atleast give you an idea of the situation... and so I would say that yes, the lady had a low glucose, but to say its 3 and she was still awake and talking is next to impossible... or so I like to think... But please correct me if I'm wrong..
Hope this helps...
samdaman
 
The only causes of a blood sugar that low are overdose on insulin or a insulinoma (B-islet cell neoplasm)...as long as you have any fat or muscle, your circulating blood sugar will be higher than 20.
 
Members don't see this ad :)
What units were they using - that ok for mmols not for mg/dl

Craig
 
I agree with the first poster. Accuchecks and chemstrips are only accurate within a certain range of blood sugars, so although the machine gave a bld glc of 3, all that means is that the sugar was too low for it to accurately measure (which is about as bad). Most of the machines I am familiar with start to crap out below 40-50.

Casey, MSIV
 
Working as a paramedic for years I've seen umpteen billions diabetics (so it seems) and we would routinely get sugars in the 12, 16, 20 range in mg/dL (they were ALL unconcious and cold, clammy and snoring by the way), but the machine seemed to read them fairly consistently.

We would redo their sugar every couple of minutes after each amp of D50 and it would come up to around 40-60 and then 80-100 and usually ended up over 140 after D50, but those are just examples.

OUr machines would not read over 400 and I believe the lower limit was 10 or 12.

they seemed accurate though. I could be wrong , but that is my personal experience. I've seen several below 20mg/dL in regular 'ole diabetics. usually in the morning after they took their insulin at night and didn't eat.

later
 
Remember, be prepared for ANYTHING happening in the ED...immaculate conceptions included.

When you walk into the ED, the laws of physics reverse and you have entered into the twilight zone...bizarro earth.
 
She didn't have any muscle or fat that I could see. And she kept passing out. The one thing she did do was sneak into the lounge and steal cups of coffee. She drank coffee as much as she could. I'm not sure if that was good for her, but I'm just a tech and am not going to second guess an attending physician. Either way she was admitted. She also kept asking about her white cell count and had edema on both wrists and ankles.

Thanks for your help everyone. Next time something like that happens I'll redo the quality control on the accucheck.

It's good to know that below 20 mg/dl the go into a coma.
 
the "20" aint set in stone, and very often you will see an Altered MEntal status or lethargy more than anything.
 
Yeah, I doubt that your patient even had a low blood sugar. The only way that you can get a low blood sugar is with insulin, and if she has an eating disorder, I doubt that she would be touching insulin as that makes people gain weight. The fact that she was so malnurished that she was edematous suggests that she has a very poor prognosis. Also, she probably was sneaking off to get the cups of coffee because coffee is a stimulant and diuretic, both of which can help people lose weight. I would have stopped her from drinking the coffee.
 
Another anecdote:
I took care of an IDDM Pt that had an accucheck of 12 mg/dL. Obviously, these machines have their limits but we can assume that the reading is lower than the 20 or 30 that it is valid...

This reading was about 15 mins after he pointed a 357 at myself and my partner off his back porch. Held it nice and steady, too.

So, was his BG higher or lower when he pointed the gun? Higher because he hadn't burned through all of his BG yet or lower and the epi rush from being threatened release some more stores? I will always wonder how low it really was. Thankfully, neither he nor us were shot and the ambulance was running when I ran from his house!
 
Got the day OFF tomorrow...

So I am gonna have me some Michelob Ultras, inebriate myself, kill some hepatocytes, and hopefully become hypoglycemic, therefore making me ravage the refrigerator during Conan.

mmmm can't wait! Of course I'll probably troll around SDN for a while too.

Q, DO
 
Originally posted by Nater44
She didn't have any muscle or fat that I could see. And she kept passing out. The one thing she did do was sneak into the lounge and steal cups of coffee. She drank coffee as much as she could.

Caffeine raises blood sugar, also.
 
Members don't see this ad :)
Originally posted by DrDre'
Another anecdote:
I took care of an IDDM Pt that had an accucheck of 12 mg/dL. Obviously, these machines have their limits but we can assume that the reading is lower than the 20 or 30 that it is valid...

This reading was about 15 mins after he pointed a 357 at myself and my partner off his back porch. Held it nice and steady, too.

So, was his BG higher or lower when he pointed the gun? Higher because he hadn't burned through all of his BG yet or lower and the epi rush from being threatened release some more stores? I will always wonder how low it really was. Thankfully, neither he nor us were shot and the ambulance was running when I ran from his house!

Tough call...I can go on record as saying that no one with a BG of under 20 will be pointing anything at anyone, and the only way to really get that low is to OD on insulin (or screw up and forget to eat after taking insulin)
 
Hm.... I was working in the ER for a Paramedic clinical when we had a elderly gentleman arrived. He's was extremely lathargic borderline unconsious. He had no medical history, I believe the brother said he had never been to the hospital. This reason was because he had a change in mental status and had be vomiting previously, so low and behold in the ER we don't do a finger stick.....(I was a student :D) Not good I know. The lab called a little later to inform us that his blood sugar was 16 :eek: . I just believe that anything is possible and never assume anything on numbers. :clap:
 
Originally posted by Idiopathic
Caffeine raises blood sugar, also.

How does caffeine raise blood sugar?

I figured she was trying to boost her energy with the coffee. The doc probably would have hooked a nice freshly brewed pot to her IV if she asked.

She was concerned about the white cell count....AIDS?
 
Caffeine raises blood sugar by inhibiting phosphodiesterase, and not allowing cAMP to be hydrolyzed to adenosine. This allows epinephrine to work longer, causing lipolysis...when you break down triglycerides, and B-oxididize fatty acids, what do you get? That's right, glucose. Some weight lifters will take caffeine supplements before workouts, as it accelerates the fat-burn (but raises blood sugar).
 
I only post this for MSI's reading so they won't miss a question on their test but Idiopathic - you know that hydrolyzing fat doesn't create glucose! The closest you can get is ketones. If anything caffeine gives you a rebound hyperglycemia through the action of glucagon.

Casey
 
The closest you can get is ketones. If anything caffeine gives you a rebound hyperglycemia through the action of glucagon.

Caffeine raises blood sugar by inhibiting phosphodiesterase, and not allowing cAMP to be hydrolyzed to adenosine. This allows epinephrine to work longer, causing lipolysis...when you break down triglycerides, and B-oxididize fatty acids, what do you get? That's right, glucose. Some weight lifters will take caffeine supplements before workouts, as it accelerates the fat-burn (but raises blood sugar).


Ahhh...Which one is it? :confused:
 
Wow, this is going back to second year stuff, but I do believe that only the liver is capable of gluconeogenisis into the blood because it has the glucose 6 phosphatase enzyme. The rest of your organs can make glucose from triglycerids and proteins, but they can't throw it into the blood like your liver can because the 6 phosphate on glucose keeps it in it's respective cell. Adipose tissue synthesizes/mobilizes free fatty acids that are sent to the liver for gluconeogensis.
 
Adipose tissue synthesizes/mobilizes free fatty acids that are sent to the liver for gluconeogensis.

FFA's are not a viable substrate for gluconeogenesis. The only part of a TG that can be made into glucose is the glycerol backbone which as you stated cannot be exported. The inability of FFA->Glc conversion is the pathogenesis of DKA.

Casey
 
Although caffeine does act as as an inhibitor of phosphodiesterases in-vitro, it probably does not work by this mechanism in-vivo due to the concentrations needed vs. typically acheived by drinking caffeinated beverages. Rather, the mechanism is thought to be by antagonism of adenosine receptors. So it will increase dopamine and norepi (and epi) levels. Caffeiene can increase blood gloucose levels somewhat. The mechanism is probably via increased hepatic glycogenolysis mediated by the increased catecolamine levels. Studies are equivocal about whether caffeine actually elevates palsma free fatty acids. If they were to be elevated they could be metabolized my working tissues thereby sparing glucose as a substrate. Lactate levels are definitely elevated which can serve as a gluconeogenic substrate.

Fredholm, BB, Battig K, Holmen J, Nehlig A, and Zvartau EE. Pharmacol Rev 51: 83-133, 1999

Bell DG, McLellan TM.
Appl Physiol. 2002 Oct;93(4):1227-34.
 
However you want to look at it...if you are using othersubastances for energy, wont your blood sugar be somewhat elevated? I have heard this from numerous sources, including biochemists. Directly or indirectly...shouldnt matter
 
I would say as a general rule no or at least not much. Even though the studies show statistically significant elevation in glycemia it is small. I geuss the bottom line is that, in the non-diabetic, the blood glucose levels are very tightly regulated with levels not dropping much below 90 mg/dl even after 12 hr fast and not getting over 200 post prandially with a raapid return to 100 give or take.
 
Top