The Effects of Low Blood Glucose on Sedation

Low blood sugarNOTE:  For those of you in other countries, or those not familiar with abbreviation of medical terms, n.p.o. is a Latin abbreviation for ‘nil per os’ or ‘nothing by mouth’.   In the U.S., this is widely practiced in IV sedation and oral conscious sedation to minimize the risk of aspiration if the vomit reflex is triggered. We recently received a call from Dr. Liscio in Vermont concerning three IV sedation patients over a period of 5 or 6 weeks who were difficult to keep in a sedated state.  He called to see if we had any insight about these very difficult behaviors and what might be causing them.

This article explores the effects of low blood glucose on sedation:

NOTE: The opinions stated in this conference call may not be the opinions of Solace Lifesciences.

This advice applies ONLY to sedation when done in combination with NuCalm using the lower doses of Nitrous, OCS, or IV medication. Please use discretion and manage your respective clinical practices based upon your skill level, expertise, and clinical philosophy. 

Excerpt from a conference call with Dr. Blake Holloway and Dr. Rex WhitemanApril 11, 2012 – 4 minutes


 
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This is from wikipedia.org on the subject of hypoglycemia:

Like most animal tissues, brain metabolism depends primarily on glucose for fuel in most circumstances. A limited amount of glucose can be derived from glycogen stored in astrocytes, but it is consumed within minutes. For most practical purposes, the brain is dependent on a continual supply of glucose diffusing from the blood into the interstitial tissue within the central nervous system and into the neurons themselves. Therefore, if the amount of glucose supplied by the blood falls, the brain is one of the first organs affected. In most people, subtle reduction of mental efficiency can be observed when the glucose falls below 65 mg/dl (3.6 mM). Impairment of action and judgment usually becomes obvious below 40 mg/dl (2.2 mM). Seizures may occur as the glucose falls further. As blood glucose levels fall below 10 mg/dl (0.55 mM), most neurons become electrically silent and nonfunctional, resulting in coma. These brain effects are collectively referred to as neuroglycopenia. The importance of an adequate supply of glucose to the brain is apparent from the number of nervous, hormonal and metabolic responses to a falling glucose level. Most of these are defensive or adaptive, tending to raise the blood sugar via glycogenolysis and gluconeogenesis or provide alternative fuels. If the blood sugar level falls too low the liver converts a storage of glycogen into glucose and releases it into the bloodstream, to prevent the person going into a diabetic coma, for a short period of time. 

Ref: http://en.wikipedia.org/wiki/Hypoglycemia#Adrenergic_manifestations

Subsequently, we arranged a conference call with Dr. G. Blake Holloway, Dr. Ed Staffel, and Dr. Liscio.

Here is a recording of the conversation (23 minutes):


 
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The Results of Dr. Liscio’s IV Sedation

What happened when Dr. Liscio followed the advice of Dr. Staffel and Dr. Holloway?Here’s the recording of their conversation (4 minutes):


 
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Recently, Dr. Liscio has switched from Ensure to a high quality organic protein shake called Orgain that he gives patients arriving at his office on an empty stomach and repeats every 3-4 hours on longer procedures.  It is available at major retailers or the best price we’ve seen online is through Amazon at $29.99 for 12 – 11 oz. servings:

Another brand that is recommended for diabetic or hypoglycemic patients is Glucerna by Abbott:

This is another area where NuCalm practices have a major clinical advantage:  NuCalm naturally lowers the metabolic rate and suppresses the vagal nerve pathway and thus minimizes gagging and suppresses the vomit reflex.

NOTE:  Another thing to be aware of during longer procedures with NuCalm is that when a patient is in a parasympathetic dominant state, the entire digestive system – including elimination steps up. Patients will have to urinate more frequently than normal, so we recommend that you give the patient a bathroom break every 2 1/2 to 3 hours and also re-nourish them with another protein drink.

It is not necessary to re-dose the NuCalm cream. The cream and the CES do most of their work in the first 15-20 minutes by interrupting the stress response of the HPA (hypothalamic-pituitary-adrenal) Axis.