high glucose emergency

[m2jpilot]

I'm a fairly new diabetic. Just tested a couple hours ago and was at 588, an hour later after 30 units was down to 498, some said I needed to go to the ER. When I was diagnosed I was in the 600's. Does a high test really mean I need to go to the ER?

[GeishaGirl]

Give it a little time -- but not too much. Sometimes the sugars will go down slowly for awhile, then crash hardcore. Give it another 1-2 hours, and test your urine for ketones if you haven't already.

I've had that happen where I'm at 400 and give the appropriate amount of insulin. At 1 hour, my sugar is only down to 370, but by hour 2 I'm at 270, and hour 3 sees me around 100.

[JediSkipdogg]

On insulin or not? If on, all the ER is going to do is give you some insulin, watch you a few hours, and bill you (or your insurance) for 2 grand. If you're on insulin, take some and see if it comes down. Test again in 30 minutes and if it doesn't drop below 500 then consider the ER.

[m2jpilot]

thanks all, kinda what I figured, but got an friend nagging me about it, told her thats all the ER would do. Definitly keep an eye on it though.

Thanks again

[JediSkipdogg]

thanks all, kinda what I figured, but got an friend nagging me about it, told her thats all the ER would do. Definitly keep an eye on it though.

Thanks again

Being a dispatcher (poline only though) you'd be amazed at some of the squad runs we assist on. The calls generally come out as diabetic emergency and then when I read the details it says BG level of 40 or 300. Ok, if 40, grab some OJ, drink it, and call me back in an hour. If 300, take a shot and call me back in an hour. Most think ER is needed when they do nothing more than the average person can do. The only difference is there you have 10 people monitoring you instead of 1 or none.

[fairyblood]

You are doing the right thing. Keep checking and have some low supplies around because 30 units is quite a bit of insulin. I often drop low when I drop 100 in an hour. Just keep your eye on it and you should be fine. Out of curiosity why do you think you got your blood sugar up there.

[m2jpilot]

yeah thats what I told her. Going to the ER was a waste of the ER's time needed for real emergencys. That I could do what they would do, she mentioned the Dr monitering it. Said I could do that myself as well. At work right now and several people around if something happened, let a couple know I was high and what to do if something did happen.

All I can imagine is I got up late today. Really late, and thus was late taking my 1st injection of the day so probably went too long with out injecting. Taking 4 shots a day. Hopefully one day the VA hosp will let me get on a pump.

[Subby]

Bearing in mind you have seem some downward movement now, it seems reasonable to monitor at home - very closely, and extremely important to keep your fluids up. A 588 is hardly cause to be casual nor considered just like a 300, as is a rather worrying line running through this thread. Go to the ER at any time you feel you need to. It is NOT a case of "wasting the doctor's time". I do not know if the description was accurate here as to US response to potential DKA as giving you insulin and booting you out the door in an hour or so, as comprehensive rehydration, possibly through drip, convincing stabilisation and further monitoring should also be part of the response. Do NOT take people's opinions here as authoritative medical advice.

[JediSkipdogg]

I do not know if the description was accurate here as to US response to potential DKA as giving you insulin and booting you out the door in an hour or so, as comprehensive rehydration, possibly through drip, convincing stabilisation and further monitoring should also be part of the response. Do NOT take people's opinions here as authoritative medical advice.

Sadly in the US alot do that. They will give you an IV to rehydrate and then add insulin to it. The problem is, depending on hospital protocols, some may or may not listen to what your correction factor is. Some will give you insulin for what they think you need and it will either drop you like a rock or do nothing. Then once you are stable for about an hour, it's out the door. In many places it's known as treat em and street em. It's a way to keep insurance costs down since one ER visit can easily cost $2000 without any tests.

[m2jpilot]

I could be way off, but if I do have insulin onboard, a DKA wouldn't be a possibility would it?

[JediSkipdogg]

I could be way off, but if I do have insulin onboard, a DKA wouldn't be a possibility would it?

Are your levels dropping? If you have insulin on board and it's working, then most likely no. You might have ketones present that could take a while to go away from the period when you had no insulin.

Do you take lantus and that's the shot that was late this morning? I know most doctors recommend doing it at night as it's generally a steadier time that you can give the same time everyday whereas with the morning you can do what you did today, sleep in and forget.

[m2jpilot]

I take 3o units of a long lasting N in the morning and 8 units of short R before each meal.

[JediSkipdogg]

I take 3o units of a long lasting N in the morning and 8 units of short R before each meal.

There's a lot of your problem. Then I see in another post you're not on insurance, so that must be why you are on N and R. N doesn't really cover 24 hours and it's highly recommended to take twice a day. Once before breakfast and once at dinner. Then the R would be taken at the same time minus lunch unless you eat a super large lunch.

I'll say this, control is very hard on those two. I did it for 20 years and never got below a 9% A1C.

[m2jpilot]

well I just got a new Dr at the VA and he seems like he knows what he is doing.. there is an insulin he wanted to put me on, the name fails me apritane or something like that and another that startted with a G, but he VA is a pain and making him do all kinds of **** before and if they will allow it, want to get on a pump, but don't even know if thats possible via the VA. I cant get my levels below 200 currently. I go back to the DR on the 24th hopefully we can get things changed.

[notme]

My guess is you are talking about glargine or Lantus which is a long acting insulin and Aprida a short acting.

It might be time for you to do some reading about carb counting and adjusting insulin on the amount of carbs you eat. This will help you prepare for pumping insulin as well as controlling your blood sugar better now.

I hope you are feeling better m2pilot.

[xMenace]

Being a dispatcher (poline only though) you'd be amazed at some of the squad runs we assist on. The calls generally come out as diabetic emergency and then when I read the details it says BG level of 40 or 300. Ok, if 40, grab some OJ, drink it, and call me back in an hour. If 300, take a shot and call me back in an hour. Most think ER is needed when they do nothing more than the average person can do. The only difference is there you have 10 people monitoring you instead of 1 or none.

Whenever they've visited me, the tests given (and reported on) are after I've come to and had lots of sugar. They don't generally test while you are convulsing.

[JediSkipdogg]

The insulin is probably Apidra and the G is most likely Glucophage. Are you a type 1 or a type 2? I would mention Metformin to him over glucophage. Depending on how stuff with the VA runs, Metformin I believe is one of those $4 a month drugs at most pharmacies now. Glucophage is the same thing but the brand name version. They basically help release the output of sugar by the liver. Nothing to help with food intake though.

Apidra will help you some, but not by itself. The NPH doesn't help at all though, that's my opinion and I'm sticking to it.

[JediSkipdogg]

My guess is you are talking about glargine or Lantus which is a long acting insulin and Aprida a short acting.

Could be the Lantus too, which would make sense. I've just never heard of a doctor referring to Lantus that way since most wouldn't have a clue on that name.

[m2jpilot]

Could be the Lantus too, which would make sense. I've just never heard of a doctor referring to Lantus that way since most wouldn't have a clue on that name.

The A one reminded me of the sweetner in diet sodas or something Aspertaine? the G was a long acting one that he said is just like a pump . One shot in the morning and is released slowly over the day. Who knows. When I go back I'll ask about it again and put the info up here. Even if I can't get on it, maybe it will help someone else.

[JediSkipdogg]

Whenever they've visited me, the tests given (and reported on) are after I've come to and had lots of sugar. They don't generally test while you are convulsing.

That's different, but in that case, I highly doubt you are the one calling 911 unless you are that skilled.

[xMenace]

That's different, but in that case, I highly doubt you are the one calling 911 unless you are that skilled.

I'm too busy holding up collapsing ceilings and testing wooden beds solidity with my feet:eek:

Do you get all the details on these reports -- who called, procedures followed, etc -- or just bare bones?

[JediSkipdogg]

I'm too busy holding up collapsing ceilings and testing wooden beds solidity with my feet:eek:

Do you get all the details on these reports -- who called, procedures followed, etc -- or just bare bones?

I get if there was a transport or not (and I would say 90+% is a not) and I know quite a few of our firefighters and have asked them procedures on numerous diabetic treatment methods to see how they would handle them.

[m2jpilot]

well down to 245 now, guess its doing better, will still keep an eye on it as 245 still stinks! thanks to everyone!!

[Subby]

As you move out of the danger zone, what you need to ask yourself is, "how did I get here"? What went wrong? Do you know? Not that you lacked insulin - that much is obvious. But what events specifically led to this. Doses, injection sites, food, activity, stress, lack of BG testing at certain times, ignoring any warning signs, you name it. You need to learn well from this.

Be careful for the next few hours and also the next 24 hours. You need to take it easy and keep sucking down fluids, these BGs wil dehydrate you a great deal. Some people like myself find that having a high will mean that for at least a day BG is likely to try and bounce back to that kind of level, think of waves taking some time bouncing back and forth in a pond, while things are choppy you need to be extra vigilant.

[AngelKitty]

Glad your BGLs are going in the right direction.
As Subby suggested, it would be really beneficial if could pin point the source of this episode - otherwise try not to stress too much - these things happen occassionally - we can only try our best :)

[sable_032592]

i've had that happen, it takes time for the insulin to start to bring it down and then once it starts, it may take an hour or so to have the full effect...

the key is not to give yourself more insulin... when my level is high, i give myself the most i'm prescribed, wait about 6 hours before i give myself anymore... by which time, i don't need another boost...

[genie86333]

I get if there was a transport or not (and I would say 90+% is a not) and I know quite a few of our firefighters and have asked them procedures on numerous diabetic treatment methods to see how they would handle them.

The rule for EMS is, if the person is a known diabetic & is having what appears to be a diabetic emergency (and can't tell you what their blood sugar is because they're not alert & oriented...or they just haven't tested) - give glucose first, then worry about testing. It's the whole "life over limb" training we get - the thinking is that if they're low, you want to get the glucose into them ASAP & if they're already so high they're having emergency issues, going a little bit higher
isn't going to be the difference between immediate life & death.

As Jedi said, most diabetic emergencies don't end up being transported. As soon as they're A&O, EMS goes on their way.

[m2jpilot]

My guess is you are talking about glargine or Lantus which is a long acting insulin and Aprida a short acting.

It might be time for you to do some reading about carb counting and adjusting insulin on the amount of carbs you eat. This will help you prepare for pumping insulin as well as controlling your blood sugar better now.

I hope you are feeling better m2pilot.

yeah,, those were it! I am definitely watching those carbs I try to keep it low, but thats what I need to learn is now to adjust for it.

[mortis505]

Just before I got my pump I spoke with my Medtronic about the VA paying for it. They said that it could be a very long and drawn out process and there would still be no guarantee that they would approve. I got my through my companies insurance to avoid the wait.

Later at one of my VA appts I asked about VA paying for pumps and my Dr said its very rare if it happens at all.

You may want to look into researching one of the organizations that assists in getting a pump. Some on here have mentioned i-pump and a few others.

[HelenM]

Hope your BG levels are down now.

Possibly he meant insulin aspart,( NovoLog/NovoRapid) which is a rapid action insulin and as other suggested, glargine (lantus), which is a basal insulin.

[m2jpilot]

Hope your BG levels are down now.

Possibly he meant insulin aspart,( NovoLog/NovoRapid) which is a rapid action insulin and as other suggested, glargine (lantus), which is a basal insulin.

Ironically the VA sent me the Lantus today, but get this says to take 30 units in the AM, then they still send 3 vials of the N long acting and say to take 30 units of that as well. 60 units? Only taking the lantus till I see the doc in a couple weeks.

Thanks for the info above on the VA as well. Kinda figured it would be a pain with them.

BTW, still running high, 187, but working on it. Thanks again to everyone!!!

[Erin]

Lantus and what else? Taking Lantus and N without a fast acting (R, novolog, humalog, apidra etc.) wouldn't be the best course of action. You need a bolus insulin too!

Lantus is way better than N tho, so congrats on the switch. (In my opinion of course)

[sable_032592]

taking lantus and N isn't recommended, it's downright dangerous, and deadly (in my opinion)... my guess is they were supposed to send you novolog or humalog or even humulin R but they made a mistake, and taking 30 units of any fast acting bolus insulin is kind of a lot, though i was originally told to take humalog in the morning, lunch and evening meal with 30 to 18 to 30 units (being am 30, lunch 18 and evening 30)...

thankfully, i don't take that much anymore... i'm still working on my insulin to carb ratio right now, but that's something for later for you... not having a bolus (fast acting) insulin is not the best of things, but my guess is by the time you get the VA involved and get this thing worked out, you'll have seen your doctor already... just keep an eye on your levels and don't overdo it with the high carb foods (junk food especially) until you see your doctor...

hang in there!