Transcript Glucagon Case Study - Telco House Bed & Breakfast

Kyle Glucagon
Glucagon Case Study
2004
Kyle Glucagon
2004
Glucagon Case Study
You are dispatched Code 3 for a Diabetic….13C2,
at 0730….You arrive at a townhouse and are led by
the parents to the upstairs. They state their son is a
insulin dependent diabetic and has been sick for
two days with flu like symptoms.
This morning they could not wake him and he sleep thru
his alarm and they called for a Ambulance. You find a
13 year old male, lying supine in bed………
Kyle Glucagon
2004
Glucagon Case Study
The parents also tell you he went to bed early last
night, and skipped his bedtime snack. Last night his
blood sugar was 4.1 mmol/l.
On Exam: No evidence of trauma
Loc—Groans to painful stimulus
Airway—Inadequate, snoring-will not take an airway
positioned ¾ prone—airway clears
Breathing—Adequate
Circulation—Easily felt radial pulse/rapid
RBS—unremarkable
Kyle Glucagon
2004
Glucagon Case Study
Should you initiate your Diabetic emergencies Protocol
or should you load and go?
What are the 4 things required to initiate your
protocol?
Kyle Glucagon
2004
Glucagon Case Study
On further Exam:
IDDM since the age of 8 years old, sick for 2 days,
infrequent episodes of hypoglycemia that are usually
resolved with food. The patient has never required
an ambulance before.
Vitals—108/64, Pulse 96 regular and easily felt,
respirations are 20 regular and adequate, skin is
pale, cool and clammy, GCS 1,2,4 = 7, O2 sat on high
flow o2 is 99%
Blood glucose is 1.7 mmol/l
Kyle Glucagon
2004
Glucagon Case Study
Patient takes Humulin N and R on a sliding scale in the
morning and evening. He has also been taking
Ibuprofen for the last 2 days. The Patient has no drug
allergies.
Kyle Glucagon
2004
Glucagon Case Study
Type of Insulin
Name
Time to Take Effect Lowest Sugar Levels Duration
Very fast acting
Lispro, humalog, novolog
5-15 minutes
60-90 minutes 4-5 hours
Regular
Humulin R
30-60 minutes
2-3 hours
5-7 hours
Intermediate Lente, Humumlin L, NPH,Humulin N
2-4 hours
4-12 hours
14-20 hours
Long Acting
Ultralente, Humulin U
6-10 hours
14-24 hours 20-36 hours
Time Release
Lantus
1-2 hours
no peak
for 24 hours
Blended
70/30, Humulin N and R
30 minutes
2-12 hours
18 hours
Kyle Glucagon
Glucagon Case Study
2004
Kyle Glucagon
Glucagon Case Study
What are the S/S of hyperglycemia?
What are the common causes of Hyperglycemia?
What are the S/S of Hypoglycemia?
What are the common causes of Hypoglycemia?
2004
Kyle Glucagon
2004
Glucagon Case Study
Common causes of hypoglycemia
include:
•
•
•
•
Taking too much insulin
Excessive exercise
Inadequate food intake
Oral Hypoglycemic Agents
Kyle Glucagon
2004
Glucagon Case Study
Common causes of hyperglycemia
include:
•
•
•
•
•
•
Failing to take insulin
Taking inadequate amounts of insulin
Infection
Excessive food intake
Pregnancy
Increased stress (both emotional and physical;
E.G., Surgery
Kyle Glucagon
2004
Glucagon Case Study
You start administering gluco-gel…..
If IV endorsed what do you do?
If you miss the IV or are not IV endorsed what do you
do?
What is the first choice, an IV or glucagon?
Kyle Glucagon
2004
Glucagon Case Study
Drug Monograph:
So we are now into the Glucagon!!!!!!!
Classification: Hyperglycemic Agent (antihypoglycemic)
Mechanism: Pancreatic Hormone, which acts on the
glycogen in the liver, converting it to glucose. Producing
a temporary rise in blood glucose. (Glycogenolysis)
Indication: Hypoglycemia (if unable to establish an IV
for ALS and EMA II, P1 hypoglycemia when patient is
unable to obey commands)
Contraindications: Known allergy to Glucagon
Pheochromocytoma (an adrenal gland tumor, can cause
sudden and marked increase in BP)
Kyle Glucagon
2004
Glucagon Case Study
Drug Monograph:
Route and Method: IM (ACP/CCP only)
SC (ACP/CCP/ PCP)
Onset/Duration: IM 8-15 minutes, 10-30 minutes
SC—similar to IM (a little slower)
Elimination: rapidly degraded by the liver, kidneys
and in the plasma. Half life 3-6 minutes in plasma
Kyle Glucagon
2004
Glucagon Case Study
Dose: Patients > 20 kg—1.0 mg
Patients < 20 kg—0.5 mg
Side Effects: Nausea and Vomiting (common)
(infrequent) Hypokalemia, Generalized allergic reaction
Hypertension, Hypo tension
Diarrhea
Increased pulse and BP
(rare)
Hypoglycemia
Kyle Glucagon
Glucagon Case Study
So back to the patient:
IV attempts are unsuccessful (or if you are not
licensed to that level…)
Lets give Glucagon:
How much Glucagon do we give to this patient?
What are the doses and weight guidelines?
2004
Kyle Glucagon
2004
Glucagon Case Study
We give the glucagon—What route and what is the
preferred site?
What do we do next?
We initiate transport, it has been about 5 minutes
after Glucagon administration, we do another set of
Vitals and find:
BP-105/68
Pulse-92
Skin-Pale, cool, clammy
Resp-20
GCS-1,2,4 = 7
Pt is unable to follow instructions, O2 saturation is
99% on high flow O2
Kyle Glucagon
2004
Glucagon Case Study
Another 5 minutes goes by:
Current Vitals: 110/70, pulse 88, resp 18, skin is pale
cool and dry, GCS is now 4,4,6 = 14, o2 sat 99%
Patient is now able to follow instructions, what do
you do now?
Kyle Glucagon
Glucagon Case Study
Commercial Break!!!!!
2004
Kyle Glucagon
2004
Glucagon Case Study
So back to the patient:
You have given gluco-gel and you are well on the way
to the hospital…current vitals are now:
BP-110/72 Pulse-82 Resp-18 Skin-Normal, Cool, Dry
GCS- 4,5,6 = 15, O2 sat 99 % on high flow
The patient is able to follow instructions, things are
looking pretty good!
The rest of the trip to the hospital is uneventful….
Kyle Glucagon
Glucagon Case Study
What is Type I Diabetes and
describe the typical patient?
What is Type II Diabetes and
describe the typical patient?
2004
Kyle Glucagon
2004
Glucagon Case Study
Oral Hypoglycemic Drugs:
There are a number of medications taken
orally to control blood sugars. These drugs
are grouped into a number of categories and
are prescribed to target certain areas of the
body, such as the liver or muscle cells.
Kyle Glucagon
2004
Glucagon Case Study
Oral Hypoglycemics:
Stimulating Insulin production:
• Diabeta, Glyburide
Decreasing Glucose Release from the Liver:
• Glucophage, Metformin
Slowing down the absorption of sugars from the Gut:
• Prandase, Acarbose
Increasing glucose Uptake by fat and muscle cells:
•Pigoglitazone, Avandia
Kyle Glucagon
2004
Glucagon Case Study
Questions:
Can glucagon be repeated if the patient doesn’t
respond to the first dose?
Do we give thiamine after administering Glucagon?
What are the chances of an overdose?
If a patient doesn’t respond to IV glucose do we give
Glucagon?
Can an IV be started on a patient after Glucagon has
been given?
Can Glucagon be used in the NYD protocol?
Kyle Glucagon
2004
Glucagon Case Study
Can we “Code X” a patient that we’ve given
Glucagon to?
Glucagon is only effective if the patient has adequate
stores of glycogen, what conditions cause depleted
glycogen stores?
What else is in the glucagon solution that we are
giving?
Will glucagon be effective if a patient has had a
hypoglycemic reaction in the last 24-48 hours?