Home Paramedicine A Finger, A Lancet, and A Glucometer

A Finger, A Lancet, and A Glucometer

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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.

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After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it? I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs. I still write about EMS, but I'm adding more and more non EMS subject matter. Thanks for visiting.

4 COMMENTS

  1. Insulin is carried by a small number of EMS services in MA who also function in the USAR Medical Specialist role. However it is not for hyperglycemia, but rather hyperkalemia. Your point is well taken that often skills are done because we can, rather than we should.

    • IIRC, that’s under the crush injuries protocol, not for medical incidents. That’s if I remember my Collapse Rescue medicine correctly.

  2. There are emergency drugs that lower BG. There are emergency drugs that elevate BG. The protocol is in place for a variety of reasons. Low BG can be easily treated very quickly and effectively. You want the patient to be conscious and cooperative if possible. The ER doctor advising EMS will take a BG reading into account when giving orders. So many thousands of people don’t even know they have Type II diabetes. If they have a 300 BGR, they are treated in the ER. If they have a 900 BGR, they will have to spend some time in the ICU being monitored for conditions that can actually kill them and they have to come down slowly. It’s a good thing to know ahead of time when seconds count and they figured that out.

    • Please name those drugs and show me which EMS systems use them. The protocols I’m familiar with specifically require BGL if the patient has AMS or as part of a Stroke Screening. There is nothing else that requires a BGL on EMS patients. I’m not familiar with a glucometer that will read above about 600 mg/dl and patients will generally present with AMS at levels that high.

      Seconds may count in hypoglycemia, but not in hyperglycemia. Where, once again, the pre hospital treatment is fluid.

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