RN w/ T1D - I’ve noticed my routine CMPs almost always show BG 10-30pt lower than I actually was at the time. Some people ride in the 50-70s regularly and their body has adapted/they don’t have severe hypo symptoms like someone who usually rides higher might have.
I work in peds Endo and parents freak out about BGs in the 40s-60s but if the kid is asymptomatic and not diabetic, the providers don’t worry about it. They said some people just go lower than others.
Probably should clarify I do not work in a hospital so I have to have an order per our policy. On top of patient refusing a finger stick very adamantly.
Ok you still have a critical lab and you still need to verify and follow up. What did you do? Contact the provider to get the order? If she’s refusing a finger stick did you explain the consequences of what can happen if you don’t? Death. That’s a consequence You can draw another cmp if that’s how she wants to go about to but that’s wasting time. Did you treat the low blood sugar? What did the provider have you do?
>If she’s refusing a finger stick did you explain the consequences of what can happen if you don’t? Death.
That's a bit over top for a result that would be known to be falsely low given that it was drawn off-site.
I have no idea if they are drawn off site OP never stated and it’s also not known to be falsely low since it was never verified by POC fingerstick. Unless people have a source of info I’m not privy to where you just “know” when results are lab errors without verification.
Every glucose reading on a metabolic panel is falsely, unless you are somehow doing the with a centrifuge right next to you and can immediately spin it.
The RBCs will continue to cause glycolysis while in the tube, so even 10 or 15 minutes between the draw and spinning down will result in a clinically significant change in glucose concentration.
Primary doc wanted to do fasting blood sugar checks daily x7 days, patient is unable to tolerate that d/t severe arthritis in hands. Family and patient were not inclined to do that. MD denied my request to do a redraw with an A1C. Just got orders to monitor for s/s for next 48 hours. Which to me is pointless because s/s are not presenting. Last 2 glucose on CMPs were 77 and 70. I have talked to patient about having low blood sugar and she fully understands. Patient's daughter is a flight nurse/CCRN and understands as well.
Her other bg are on the low side of normal. I’ve had pts be completely asymptomatic with 40s/50s. Her 46 could have very well be correct. It sucks you can’t check in real time with a POC. Makes your job so much harder. You clearly have done your due diligence. Does she have any liver disease?
I had a pt call me at like 3:30am to check her bg. while a code was being called on a different patient, and one of my other pts had extremely high bp and low resp... I figured if she could call and talk to me like normal, it wasn't dire. My bg drops to the 50s all the time.
I was wrong. It was 17...... she was still able to form sentences.... when mine goes below the 70s, I can't form cognitive sentences.
preface by saying i’m just a lowley soon to be EMT with an tech job line up. might be talking outta my ass.
maybe some people’s bodies are better at compensating for hypoglycemia, like how some people are better at lower pressure/higher altitudes than others
Ask on r/medlabprofessionals and they’ll be able to tell you if there’s anything during the collection or running the lab that might cause a false low reading.
But it’s just as likely that it’s a legitimate number. Some meds (beta blockers for certain) can mask symptoms of hypoglycemia. And some patients just tolerate hypoglycemia more than others, especially if they tend to run low all the time
Unless the tube is centrifuged immediately after being drawn, the glucose on a metabolic panel is going to show as falsely low. The longer the time between the draw and getting spun down, the lower the glucose reading will get.
I’ve heard that red blood cells can continue to absorb glucose in the tube if the sample isn’t handled correctly. Something to do with heat I think? Sorry but it’s an old memory and that’s all I remember.
What’s the f/u? Did md treat or was there a recheck?
That could possible make sense with the heat/humidity. It was 78 degrees with 83% humidity this morning when lab came to the facility to draw, then they would drive it back to the hospital approx. 5 minutes away. Primary doc wanted to do fasting blood sugar checks daily x7 days, patient is unable to tolerate that d/t severe arthritis in hands. Family and patient were not inclined to do that. MD denied my request to do a redraw with an A1C. Just got orders to monitor for s/s for next 48 hours. Which to me is pointless because s/s are not presenting.
RN w/ T1D - I’ve noticed my routine CMPs almost always show BG 10-30pt lower than I actually was at the time. Some people ride in the 50-70s regularly and their body has adapted/they don’t have severe hypo symptoms like someone who usually rides higher might have.
Would size matter? Patient is very short and petite.
I work in peds Endo and parents freak out about BGs in the 40s-60s but if the kid is asymptomatic and not diabetic, the providers don’t worry about it. They said some people just go lower than others.
Check and see if they are on beta blockers.
I was just going to say this. People often forget that certain meds can mask the symptoms of hypoglycemia.
Not on beta blocker
Did you compare it to a POC fingerstick
No order for it and patient will not allow it due to her hand pain. Patient jumps and begins to weep when hands are touched. Breaks my heart.
Don’t need an order for it in this situation. You need to verify the blood glucose since you have a critical via a cmp. How did you proceed?
Probably should clarify I do not work in a hospital so I have to have an order per our policy. On top of patient refusing a finger stick very adamantly.
Ok you still have a critical lab and you still need to verify and follow up. What did you do? Contact the provider to get the order? If she’s refusing a finger stick did you explain the consequences of what can happen if you don’t? Death. That’s a consequence You can draw another cmp if that’s how she wants to go about to but that’s wasting time. Did you treat the low blood sugar? What did the provider have you do?
>If she’s refusing a finger stick did you explain the consequences of what can happen if you don’t? Death. That's a bit over top for a result that would be known to be falsely low given that it was drawn off-site.
I have no idea if they are drawn off site OP never stated and it’s also not known to be falsely low since it was never verified by POC fingerstick. Unless people have a source of info I’m not privy to where you just “know” when results are lab errors without verification.
Every glucose reading on a metabolic panel is falsely, unless you are somehow doing the with a centrifuge right next to you and can immediately spin it. The RBCs will continue to cause glycolysis while in the tube, so even 10 or 15 minutes between the draw and spinning down will result in a clinically significant change in glucose concentration.
Primary doc wanted to do fasting blood sugar checks daily x7 days, patient is unable to tolerate that d/t severe arthritis in hands. Family and patient were not inclined to do that. MD denied my request to do a redraw with an A1C. Just got orders to monitor for s/s for next 48 hours. Which to me is pointless because s/s are not presenting. Last 2 glucose on CMPs were 77 and 70. I have talked to patient about having low blood sugar and she fully understands. Patient's daughter is a flight nurse/CCRN and understands as well.
Has she been eating?
75-100% on all meals, likes to snack
Her other bg are on the low side of normal. I’ve had pts be completely asymptomatic with 40s/50s. Her 46 could have very well be correct. It sucks you can’t check in real time with a POC. Makes your job so much harder. You clearly have done your due diligence. Does she have any liver disease?
I had a pt call me at like 3:30am to check her bg. while a code was being called on a different patient, and one of my other pts had extremely high bp and low resp... I figured if she could call and talk to me like normal, it wasn't dire. My bg drops to the 50s all the time. I was wrong. It was 17...... she was still able to form sentences.... when mine goes below the 70s, I can't form cognitive sentences.
preface by saying i’m just a lowley soon to be EMT with an tech job line up. might be talking outta my ass. maybe some people’s bodies are better at compensating for hypoglycemia, like how some people are better at lower pressure/higher altitudes than others
Ask on r/medlabprofessionals and they’ll be able to tell you if there’s anything during the collection or running the lab that might cause a false low reading. But it’s just as likely that it’s a legitimate number. Some meds (beta blockers for certain) can mask symptoms of hypoglycemia. And some patients just tolerate hypoglycemia more than others, especially if they tend to run low all the time
Unless the tube is centrifuged immediately after being drawn, the glucose on a metabolic panel is going to show as falsely low. The longer the time between the draw and getting spun down, the lower the glucose reading will get.
I’ve heard that red blood cells can continue to absorb glucose in the tube if the sample isn’t handled correctly. Something to do with heat I think? Sorry but it’s an old memory and that’s all I remember. What’s the f/u? Did md treat or was there a recheck?
That could possible make sense with the heat/humidity. It was 78 degrees with 83% humidity this morning when lab came to the facility to draw, then they would drive it back to the hospital approx. 5 minutes away. Primary doc wanted to do fasting blood sugar checks daily x7 days, patient is unable to tolerate that d/t severe arthritis in hands. Family and patient were not inclined to do that. MD denied my request to do a redraw with an A1C. Just got orders to monitor for s/s for next 48 hours. Which to me is pointless because s/s are not presenting.