Someday, someone might be able to explain to me the preoccupation many EMS providers have with obtaining a Blood Glucose Leve (BGL) on every single patient they encounter.
I know that Type 2 diabetes is a problem in this county, however it’s not a problem that EMS is really trained, equipped, or educated to treat. Other than the occasional patient with an incredibly high BGL and Altered Mental Status (AMS), there is really no path to treatment for EMS.
Yet, providers of all levels have a bizarre obsession with sticking a needle in a patient’s finger to see if they are hyper or hypoglycemic. Patients can be substantially hyperglycemic with no outward signs of it. Again, AMS is the exception.
Treating hyperglycemia involves admitting the patient to the hospital and oh so carefully administering Insulin and IV fluids to get the glucose levels under control. While EMS can give fluid, and often does even if not required or beneficial to the patient, I don’t know of a US EMS system that carries Insulin in any form.
Hypoglycemia almost always manifests itself in the form of AMS as while the body can function fairly well with a low BGL, the brain needs glucose to work properly. Which is why EMS protocols everywhere indicate a BGL check for AMS, even if the patient is not a diabetic.
Non diabetics use naturally produced insulin to help the brain metabolize glucose. It also performs other functions in the brain that are not well understood by science. Type 1 diabetics don’t produce insulin or don’t produce enough insulin for this process to work. Which is why they take Insulin.
The problem is when they take insulin, but don’t eat. The insulin burns off whatever glucose is in the patients body to the level where the brain can’t function normally.
So, I get that in any patient with an Altered Mental Status checking the BGL is prudent. What I don’t get is why a 25 year old female who twisted her ankle, needs a splint, ice pack, and a ride to the hospital needs to have her BGL checked.
What is the diagnostic purpose of performing a test on a non diabetic who is complaining about the pain and swelling in her ankle and really wants pain relief?
It seems that some people in EMS are doing things out of habit or misunderstanding of the protocol. Or a total lack of understanding of anatomy, physiology, and good medicine.
As a cynical veteran paramedic (is there any other kind) once commented, “Learn to do without knowing why.”
That’s today’s mini rant. As always, comments are appreciated.