As a Diabetes Counselor for CPMC and married to a type I diabetic for nearly 25
years I would say that a small, 6 oz. box of juice is not a bad idea, however,
keep in mind that just giving sugar “Just in case” can indeed sky rocket an
individual’s blood sugars. Depends on their equilibrium, weight, and normal
time of having a snack. I would only prophylactically “sugar them up” after
talking with the patient and determining what their normal routine is. Most
diabetics know their needs. Rub their arm- check for clamminess (
diaphoresis). Are they clammy? Are they spacey?
In a hospital setting like ours, we are not allowed to test their blood sugars
pre procedure. This requires a laboratory license. In a private practice one
can pretty much do what they think they can get away with.
Most patients do not travel with their glucometers, in my experience; however,
they generally know if they take a snack around 10:00 or noonish.
See my article “Is it Hypoglycemia?” in the Journal of Nursing and Technology.
Even though published in 1988 not much has changed other than the convenience
of small glucometers and computerized data tracking.
I always keep juice boxes in our photo suite. Sugar only temporarily stabilizes
a diabetic. One must follow up with a slower glycemic carb, or even better,
about 5-6 ounces of protein.
Hope this helps!
Denice
From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On ;
Behalf Of lguerette@xxxxxxxxxxxxxxxxx
Sent: Saturday, March 11, 2017 5:47 AM
To: optimal@xxxxxxxxxxxxx
Subject: [**External**] [optimal] Re: 10% vs 25% Fluorescein
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Speaking of hypoglycaemia, years ago we started giving our diabetics a small
juice box before the FA to avoid that sugar crash. I haven't been taken down
by 250 lbs of dazed confusion since (the patient was a lot bigger than I am,
and trying to ease him down to the floor as he fainted then seizured wrenched
my bad back).
Anyone else use this or a similar method?
Plus a wintergreen lifesaver for those that are just queasy - helps get rid of
the metallic taste of the dye and the rest of the session goes fine.
Lori
Lori Guerette, CRA COA OCT-C
May you find your marbles,
And recall the carefree joy of childhood
On Mar 11, 2017, at 7:48 AM, Patti Kish
<photohomer@xxxxxxxxxxx<mailto:photohomer@xxxxxxxxxxx>> wrote:
I so agree on those silly kidney basins. Will keep an eye on all that you have
mentioned in your discussion, Mr. Morrone.
________________________________
From: optimal-bounce@xxxxxxxxxxxxx<mailto:optimal-bounce@xxxxxxxxxxxxx>
<optimal-bounce@xxxxxxxxxxxxx<mailto:optimal-bounce@xxxxxxxxxxxxx>> on behalf
of Richard Morrone <rmorrone@xxxxxxxxxxx<mailto:rmorrone@xxxxxxxxxxx>>
Sent: Friday, March 10, 2017 1:46 PM
To: optimal@xxxxxxxxxxxxx<mailto:optimal@xxxxxxxxxxxxx>
Subject: [optimal] Re: 10% vs 25% Fluorescein
Coy,
For what it's worth, I pulled these two studies on injection speed for you (see
attachments). If they don't attach, let me know, and I will email you
separately. Of course, the results are the opposite. I could not find
anything on adverse reactions based on the concentration of dye, nor have I
ever heard of any.
As to nausea and vomiting, I prefer the 1cc-per-second approach. I agree with
Lori that we have to look elsewhere for causes. There's the way that the dye
is similar to chemotherapy drugs in the crossing of the blood/brain barrier.
And frankly, I need all the fluorescence I can get to avoid hitting the patient
with higher flash levels. I've had the dye myself on 8 occasions as the
subject for testing camera systems or filters, etc. I got the nausea 4 times,
and on 2 of those 4 times I tossed my cookies. Same 5cc and 5-second push each
time.
Being a hypoglycemic myself, I have always suspected blood sugar as a
contributing factor.
I've been at this for 43 years, and throughout this time my incidence of nausea
has been more like 2 to 3%, with vomiting below 1%. All I can say is that I
try to provide a lot of levity to balance the hard work that I will be putting
the patients through. I have joked during a lengthy color montage prior to the
FA that my hobby before getting into this work was torturing small animals,
resulting in laughter and a playfully snide comment from the patient. The
nurses and I have our comedy act worked out as well. In this I play the foil
to the nurse and patient ganging up on me. All this distraction occurs without
missing a beat as we take care of business.
If the nausea hits we get the 13" wide pail (forget those silly kidney basins),
and the nurse places an alcohol wipe under the patient's nose and asks them to
breath deeply and slowly. The alcohol acts sort of like smelling salts or
ammonia capsule, but a lot milder. Between the alcohol, the attention and the
calming, we get through the nausea quickly and move on.
Richard Morrone, C.R.A.
On Friday, March 10, 2017 5:47 AM, "Egnatz, Thomas"
<tegnatz@xxxxxxxxx<mailto:tegnatz@xxxxxxxxx>> wrote:
I am posting this for Coy. Sorry about the delay, I have been off Optimal for
a month (new computer).
Tom
From: Cobb, Coy, VHACIN
Sent: Thursday, February 16, 2017 9:22 AM
To: 'optimal@xxxxxxxxxxxxx<mailto:optimal@xxxxxxxxxxxxx>'
Subject: 10% vs 25% Fluorescein
Morning all
Would anyone know of any studies comparing 5cc’s of 10%, verses 3 cc’s of
25% fluorescein ?
Specifically, I’m looking for anything that addresses adverse reactions.
Coy Cobb COT CRA
