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Hypoglycemia

Rob Orman, MD and George Willis, MD
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24:04
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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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03:41

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EM:RAP 2017 June Written Summary 647 KB - PDF

When D50 is given to a patient with a functioning pancreas, there might be a heavy insulin release leading to recurrence of hypoglycemia. Consider using 100cc of D10 which may have less rebound hyperglycemia.

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Xander Merboo -

Surprised to see the recommendation that Etoh patients in this subset need thiamine. If I remember correctly, the papers that debunked the need for banana bags showed that none of their screened ETOH patients had vit B deficits. Why the recommendation?
Thanks!

Mike D. -

The Medical Letter (1/16/17) classifies Levemir (insulin detemir) as long acting insulin similar to Lantus (insulin glargine). The letter states glargine has no peak and detemir is relatively flat. The Letter does not say Levemir has a peak in 6 to 8 hours but does state the intermediate acting NPH (Humulin and Novolin N) has a peak in 4 to 8 hours. Can George comment on the delayed risk of hypoglycemia from NPH vs detemir (Levemir)?

Evan G. -

NPH has a much bigger peak the levemir, so when it is dosed in the morning you have the peak hit at lunch time. So not eating at this time can result in low blood sugar. One thing not discussed is when people accidentally double dose their lantus (forgetting they took it once). This could cause prolonged hypoglycemia and may require admission. Don't forget about insulin pumps. If someone on a pump is having trouble with lows, it's easy to have them cut their basal rates back temporarily

Ziyad K. -

Have there been any studies which compare administration of D50 vs. D10 for glucose concentration over time? It was noted in the summary that "data is limited" but I was wondering what the data is, or if this is expert opinion? Thanks very much.

James C. -

What about all these newer Stigaliptins and the such? Are these apt to cause hypoglycemia?

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Don’t Fear The Stink! Full episode audio for MD edition 245:23 min - 342 MB - M4AEM:RAP 2017 June Canadian Edition Canadian 24:49 min - 34 MB - MP3EM:RAP 2017 June German Edition Deutsche 68:28 min - 94 MB - MP3EM:RAP 2017 June French Français 29:35 min - 41 MB - MP3EMRAP 2017 June Resumen Español Español 94:49 min - 130 MB - MP3EM:RAP 2017 June Board Review Answers 187 KB - PDFEM:RAP 2017 June Board Review Questions 170 KB - PDFEM:RAP 2017 June MP3 328 MB - ZIPEM:RAP 2017 June Written Summary 647 KB - PDF

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