I trust the collective wisdom here more than my doctor to shed some light. Two days in a row I had staggering afternoon lows, unlike anything I've experienced. EMS left a few hours ago. Thankfully, my husband was home to call EMS because I was unable to speak or move. He tested me. BG 37, which has never left me near comatose before. Ok, here's the strange part. I had taken Apidra 7 hours before the low. None should have been available to cause a plummet. Also use Levemir. If I accidentally took two Apidra shots (sure I didn't), I would have been dead before I hit the floor. I'm careful about rotating injection sites & take small doses, so I don't think it was a scar tissue absorption delay. No exercise to account for a low either.
EMS injected IV dextrose because glucagon would have taken too long. A minute or so later, I was able to talk. BG went to 315 after the dextrose & then dropped to 223 10 minutes later & then to 175 after I ate crackers with peanut butter & is holding at 175. Needless to say, I'm terrified to take a correction to bring it down.
Thanks for your isights!
That's great that you've already fixed it yourself, without needing to see the doctor!
Time will tell if I fixed it with basal adjustments, but couldn't have done without a little (a lot) help from my friends!
I get by with a little help from my friends....... :)
Heard the song in my head:)
Wanted to pass on important info, courtesy of Bradford, in case anyone finds themselves in need of the info. I was questioning how my BG could drop almost 100 pts 315 within 10 minutes with no rapid acting on board & continue to fall.
From Bradford & Brooke, a pharmacist:
"Since it's IV dextrose, it's 'into' and 'out of' the system very quickly. So that's why the spike up and then the quick return down to 175. I know the time has passed to offer helpful advice for the situation, but they recommended not bolusing for about 4 hours or so afterwards with regard to a correction (for the 175) to ensure that the added insulin did not send you into a hypo event again. They did, however, recommend bolusing if you were to eat a meal within that 4 hour time span, and then to continue like normal after that time."
EMS didn't caution me about not correcting for four hours.
Question: How does it get out of the system? Where does the dextrose go?
My guess is that it's rapidly taken up by the cells & then excreted. From my experience, it sure didn't remain in my blood long as evidenced by the rapid decline with nothing but basal on board. My IV shot was followed by a small amount of saline solution.
Gerri's answer is pretty much dead on, except once in a cell, it will be metabolised pretty quickly into carbon dioxide and water. It won't be excreted from any cell it enters.
It's an intravenous injection which means that it doesn't have to be digested through the gut or any other tissue for that matter. That cut's down on a lot of the processing time. Cells will have access to it immediately, and since it raises BG so quickly, that means that as long as there is insulin present, the huge concentration gradient from blood to cell will drive rapid movement into the cells.
Also, as with any high BG, you'll be excreting excess dextrose, any that doesn't enter a cell, through the kidneys into urine.
Thanks for a more thorough explanation. Dextrose IV is the way to go. Heard from Melissa BL., who's father is a paramedic. He said dextrose IV is what's commonly used, not glucagon.
Yeah, my brother in law is a paramedic. I've seen him in action on ride along or two. Never personally experienced it, but I've definitely seen it done.
Hope it's something you never have to experience again Gerri.
I sure hope not, thanks.
I want to start a discussion about self-treating with IV dextrose because of the expense, expiration & side-effects of glucagon & mostly because IV dextrose is faster acting. Would you mind asking your brother-in-law if he thinks this is feasible & where training for this may be available?
A very intriguing idea. I would very much like to see a discussion of this.