Diabetic Patients with Low Blood Glucose-Should They Refuse?

Diabetic Patients with Low Blood Glucose-Should They Refuse?

There is no perfect yes/no answer to this question.  Each patient and event has specific circumstances that will lead you to the best answer.

Patients with low blood glucose (less than 60 mg/dL) require treatment of some sort.  This might include food, orange juice, oral glucose, glucagon or dextrose.  Some patients may be unconscious with a reading at 30 and others barely seem symptomatic.  But a low reading will not increase on its’ own.

History:  If the patient has been busy and simply forgot to eat, they can be a candidate to refuse transport.  A patient who has been having trouble regulating their blood glucose recently, lost weight, has been ill, etc. should be seen by a physician to rule out other causes or change medications dosage.  Anyone without a history of diabetes should be evaluated by a physician as well.

Patient medications: There are numerous types of medications to treat both Type I and Type II diabetes.  Some are short acting, meaning they work and don’t linger in the patient’s system.  Others, can continue to have effects up to two days later. Many patients are on multiple medications which can enhance the hypoglycemia.

  • Specifically, the Sulfonylurea and Meglitinide class oral agents such as glyburide, Micronase, Diabeta, Glucotrol, glipizide, Amaryl, Glyburide, glimepiride, Tolinase, Orinase, Diabinase, chlorpropamide, Starlix, and Gluconorm have a high likelihood of causing hypoglycemia.
  • Both of these stimulate the pancreas to release more insulin.  They tend to work for at least 12-24 hours which means the patient can easily have another episode of low blood glucose.  Patients on these medications should be transported for continued monitoring.  The Sulfonylurea class drugs combined with NSAIDs or sulfonamides can increase chances of hypoglycemia.
  • The other 3 classes of oral agents tend not to cause hypoglycemia but some medications are combined and given a new name such as Glucovance (Glyburide/Metformin)

If allowing the hypoglycemic patient to refuse, you should ensure their blood glucose level has returned to a normal level, they have a plan, they are monitored by friends or family and are eating or will be very soon.  They should also be encouraged to document the event and contact their primary care physician to discuss the episode.

If there are any doubts about allowing the patient to refuse transport, the AIC should contact medical control for specific advice.  Sometimes the patient will listen to the second opinion.