Message from: Dr. O. Wilhelm, Director of Endocrinology
Currently there is a nationwide shortage of D50, including both vials and Abbojects, commonly used to treat hypoglycemia. This shortage is expected to last until at least September/October. The current hypoglycemia policy guides nurses to treat hypoglycemia first by following the “Rule of 15" which treats patients orally with juice, soda, glucose tabs or glucose gel. If a patient is combative, semi-conscious, seizing, unconscious or cannot swallow, the Rapid Response Team should be immediately activated and the nurse would prepare to administer D50. D50 will not be available at this time until further notice. Glucagon supplies are also low at this time.
The following recommendations have been made:
1. When treating hypoglycemia (Policy CP 17.00) when possible treat orally. All units are stocked with both glucose tablets and glucose gel. The glucose gel should be attempted with patients not able to drink juice or chew tablets. The glucose gel can be absorbed bucally.
2. For the patient who is combative, semi-conscious, seizing, unconscious and/or who cannot swallow immediately activate the Rapid Response Team and alert the attending physician.
A. Establish an IV line (if one is not already in place), and prepare to administer 10% Dextrose IV. (This will be stocked on all units in either 250ml or 500 ml bags.)
Dosing: for 12.5 g of Dextrose administer 125ml over 5* min
For 25mg of Dextrose administer 250ml over 10* min
*For CHF or ESRD patients you may run over 30 min duration
B. Glucagon 0.5 mg or 1 mg may be administered IV or IM in patients who are unable to swallow. Please note onset for IV and IM is 5-20 minutes. Please consider using oral glucose gel bucally while waiting for Glucagon to work.
3. The MDN Glucose Stabilizer currently makes specific recommendations for dosage of D50 when a paient’s blood sugar falls below 70 mg/dl. This feature will be temporarily disabled. The nurse will now receive a message when blood sugar is below 70 mg/dl that states “BG is low, Administer hypoglycemic protocol”. * We recommend 25 mg of 10% Dextrose for BG below 50 mg/dl and 12.5 mg of 10% Dextrose for BG between 51-70 mg/dl.