Diabetes Talking

Question:

Hello all, Rob Carr schrieb: Thinking about it, the EMS personnel may have chosen milk, not because the patient was in such an "extreme" hypoglycemic state, but because she was in such a mild state.

or they were using it, because it was closer by, instead of everything else. I remember US-supermarkets to be very large, so instead of running around for 5 minutes, just grab whats close by and "adequate". best wishes andy r.

Response:

   I saw milk used in a Krogers.  The lady went down and couldn’t get up but she was awake.  The EMS grabbed milk from the dairy area and used it to bring her back.   I report this episode not as a primer on EMS but a warning to milk drinkers.  I was surprised at the EMS response cause I thought milk was on the slow side (theory only).  After that episode, I started experimenting with my breakfast oatmeal and found that I too respond very rapidly to milk.

Even when I first started with diabetes, milk didn’t cause me problems. Since it only contains 13 g. of carbohydrate per 8 oz (skim), it’s wasn’t hard for me to tolerate even early on.  Looking back on my notes from my CDE, she was the one who suggested the milk for breakfast. Thinking about it, the EMS personnel may have chosen milk, not because the patient was in such an "extreme" hypoglycemic state, but because she was in such a mild state. Rather than blowing her BG sky high (the traditional response by EMS to hypoglycemia), the medic may have been smart enough to realize that even the traditional glass of OJ may would have overdone things. The milk, because it contains sugar, protein, and (assuming the medic didn’t go for skim) fat, would have had a longer-term effect on the patient’s BG. Of course, it may simply have been that the patient went down in the dairy isle and the OJ wasn’t nearby. I don’t know how Krogers is laid out. Strangely enough, I know a paramedic who used to manage a Krogers. — Rob I’m running for my life! Rome Marathon to raise money for the ADA

Response:

– Hide quoted text — Show quoted text – Buttermilk or regular milk (all kinds, skim, whole, etc) are such fast carbs that Emergency Medical Services use them as antidotes for extreme hypoglycemic episodes. No EMS service would ever dare use anything given orally in the case of an extreme hypoglycemic episode. The patient cannot protect the airway and the result might be aspiration, if not respiratory arrest. In the case of a patient unresponsive to glucagon and without IV access and with the patient intubated, an NG tube could be placed and a glucose solution administered.  That’s still not considered "oral." The preferred method is the administration of D50 by IV push through a reliable IV site. D50 infiltration is to be avoided. If an IV site cannot be secured, glucagon is used in some systems as a drug of last resort or, in some cases, when the patient is too violent for the establishment of an IV. . . . For the patient who is still capable of protecting the airway, oral administration can be used, although with extreme caution. A sudden decrease in the level of consciousness of the patient can turn a simple case of hypoglycemia into an iatrogenic disaster. I personally dislike glucose tablets and gels for this reason – they can make airway control exceptionally difficult if the patient crashes. As far as fluids given to the awake patient protecting their own airway, often the fluid used is the fluid at hand.  I’ve heard reports of orange juice, Coke, milk, buttermilk, coffee, and Lactated Ringers. In the case of the last 4, sugar was added to increase the amount of sugar available to the patient. I don’t want to think about sugared buttermilk. Lactated Ringers has such a foul taste that I cannot understand why IV acces was not used instead. Orange juice or soft drinks or sugar water are the usual methods, again with sugar added if possible. — Rob

   I saw milk used in a Krogers.  The lady went down and couldn’t get up but she was awake.  The EMS grabbed milk from the dairy area and used it to bring her back.   I report this episode not as a primer on EMS but a warning to milk drinkers.  I was surprised at the EMS response cause I thought milk was on the slow side (theory only).  After that episode, I started experimenting with my breakfast oatmeal and found that I too respond very rapidly to milk. — Old Al (T1x since 94, 35 units H + U via 4 injections daily)     A retired engineer who shares his experiences

Response:

Buttermilk or regular milk (all kinds, skim, whole, etc) are such fast carbs that Emergency Medical Services use them as antidotes for extreme hypoglycemic episodes.

No EMS service would ever dare use anything given orally in the case of an extreme hypoglycemic episode. The patient cannot protect the airway and the result might be aspiration, if not respiratory arrest. In the case of a patient unresponsive to glucagon and without IV access and with the patient intubated, an NG tube could be placed and a glucose solution administered.  That’s still not considered "oral." Trust me, the comments about administering D50 down the endotracheal tube are meant as a joke. It’s typical medic gallows humor, and a poor choice at that. There’s bound to be some moron that would not get the joke and actually try it. <shudder The preferred method is the administration of D50 by IV push through a reliable IV site. D50 infiltration is to be avoided. If an IV site cannot be secured, glucagon is used in some systems as a drug of last resort or, in some cases, when the patient is too violent for the establishment of an IV. For the patient who is still capable of protecting the airway, oral administration can be used, although with extreme caution. A sudden decrease in the level of consciousness of the patient can turn a simple case of hypoglycemia into an iatrogenic disaster. I personally dislike glucose tablets and gels for this reason – they can make airway control exceptionally difficult if the patient crashes. As far as fluids given to the awake patient protecting their own airway, often the fluid used is the fluid at hand.  I’ve heard reports of orange juice, Coke, milk, buttermilk, coffee, and Lactated Ringers. In the case of the last 4, sugar was added to increase the amount of sugar available to the patient. I don’t want to think about sugared buttermilk. Lactated Ringers has such a foul taste that I cannot understand why IV acces was not used instead. Orange juice or soft drinks or sugar water are the usual methods, again with sugar added if possible. — Rob I’m running for my life! Rome Marathon to raise money for the ADA

Response:

– Hide quoted text — Show quoted text – Hi Old Al, Old Al schrieb:  Buttermilk or regular milk (all kinds, skim, whole, etc) are such fast carbs that Emergency Medical Services use them as antidotes for extreme hypoglycemic episodes. nope, emergency medical services use glucose intravenous, if unconscious or the patient is not able to swallow. If the patient is still able to react, I have seen glucose tablets and/or fruit juice. Fruit juice has about 2 to 3 times as many carbs as milk, so the amount is much smaller. I have never seen milk used, but then again, different coutries, different practices. best wishes for the next millenium andy r.

    I saw an EMS team use milk once.  Surprised me at the time but then my struggle with 9 am highs became a bit more understandable.   In the U.S., EMS also carries a tube of glucose suspension with the consistency of toothpaste.  They will work to squirt(?) it into the mouth of the semi-functional patients.  Saw that once too.  The tube is 50 gram of glucose but as much or more ends up on the outside of the patient as the inside.  Bright pink.  Everybody in the medical team knows it’s been used.  There are some clever people in that field. — Old Al (T1x since 94, 35 units H + U via 4 injections daily)     A retired engineer who shares his experiences

Response:

Hi Old Al, Old Al schrieb:  Buttermilk or regular milk (all kinds, skim, whole, etc) are such fast carbs that Emergency Medical Services use them as antidotes for extreme hypoglycemic episodes.

nope, emergency medical services use glucose intravenous, if unconscious or the patient is not able to swallow. If the patient is still able to react, I have seen glucose tablets and/or fruit juice. Fruit juice has about 2 to 3 times as many carbs as milk, so the amount is much smaller. I have never seen milk used, but then again, different coutries, different practices. best wishes for the next millenium andy r.

Response:

type II, 500 mg glucophage x2

 In response to Andy’s comments on buttermilk for breakfast i.e. Ted said Lately, I’ve been drinking about 1/2 cup of buttermilk with my meds in the morning, hoping this is better for me than fruit juice.

  Andy replied to Ted buttermilk contains the same amount of carbs as regular milk, that being 12g carbs for 250 ml (about 1/2 pint). Many of the fruit juices available here in Germany are counted as 12g carbs per 100 ml. What type diabetes do you have? Do you take insulin or oral meds or just diet and exercise? Neither the milk nor the fruit juices are "bad". But all liquids have a very rapid effect on the BG. Personally I only drink fruit juices when I have a hypo, because I refuse to shoot insulin for drinks when I could rather have something to eat. best wishes andy r.

   Ted:  Buttermilk or regular milk (all kinds, skim, whole, etc) are such fast carbs that Emergency Medical Services use them as antidotes for extreme hypoglycemic episodes.   I am a humalog insulin shooter.  Therefore, I can get by (but only barely) with diluted milk (2/3 milk, 1/3 water) in my morning oatmeal. I could not do that when I was on glucophage. — Old Al (T1x since 94, 35 units H + U via 4 injections daily)     A retired engineer who shares his experiences

Response:

typeII, 500 mg glucophage x2 Ted

– Hide quoted text — Show quoted text – Hi Ted, ted schrieb: Lately, I’ve been drinking about 1/2 cup of buttermilk with my meds in the morning, hoping this is better for me than fruit juice. buttermilk contains the same amount of carbs as regular milk, that being 12g carbs for 250 ml (about 1/2 pint). Many of the fruit juices available here in Germany are counted as 12g carbs per 100 ml. What type diabetes do you have? Do you take insulin or oral meds or just diet and exercise? Neither the milk nor the fruit juices are "bad". But all liquids have a very rapid effect on the BG. Personally I only drink fruit juices when I have a hypo, because I refuse to shoot insulin for drinks when I could rather have something to eat. best wishes andy r.

Response:

Hi Ted, ted schrieb: Lately, I’ve been drinking about 1/2 cup of buttermilk with my meds in the morning, hoping this is better for me than fruit juice.  

buttermilk contains the same amount of carbs as regular milk, that being 12g carbs for 250 ml (about 1/2 pint). Many of the fruit juices available here in Germany are counted as 12g carbs per 100 ml. What type diabetes do you have? Do you take insulin or oral meds or just diet and exercise? Neither the milk nor the fruit juices are "bad". But all liquids have a very rapid effect on the BG. Personally I only drink fruit juices when I have a hypo, because I refuse to shoot insulin for drinks when I could rather have something to eat. best wishes andy r.

Response:

I’ve been having problems with morning highs.  I’ve stopped eating breakfast until I actually start getting hungry, about 2-3 hrs after I wake up.  I was told, on this ng, that I really need to break my fast and have something to eat.  Lately, I’ve been drinking about 1/2 cup of buttermilk with my meds in the morning, hoping this is better for me than fruit juice.  Then, when I do get hungry, I eat some peanuts or some of those cute little baby carrots. Or maybe I’ll have some fat-free yogurt.  This seems to help some.  I had hbaic test done today.  Doc will call next week with results. I loooove buttermilk, so I’m sure it’s not good for me.  Like all the other foods I really like. Ted.  No, not THAT Ted.

Response: