I would like some information concerning why it is better to give a patient who had “bottomed out” a glass of milk versus a glass of orange juice with of sugar in it. Many of the nursing homes and, I believe, two local hospitals, have developed the protocol of giving a patient one or two glasses of milk with a graham crackers versus the usual OJ with sugar in it. I would very much like to know more about this theory to bring it to my nurse manager.

I must confess that I don’t know. Maybe it’s the protein in it all. I am a fan of glucose tablets, glucose gel and glucose, not any other form of sugar, first. Then feed.

LD

[Editor’s comment: I agree with Dr. Deeb, but let me explain a little more. When someone has a hypoglycemic reaction, it is extremely important to raise the glucose level quickly. In the case of hospitalized or nursing home patients, there might also be a degree of hypoglycemia unawareness, which makes this even more important.

The first step in treating low blood sugar is always to use a form of rapid-acting sugar. These days, we suggest ideally, glucose tablets or gel, but juice with sugar can be used if these are not available. This should be followed by something like milk and graham crackers. The problem with using the milk and graham crackers as initial treatment is that both (particularly if whole milk is used) contain fat which slows down the absorption of glucose enormously. The carbohydrate in these foods is in a more complex form and takes a while to be converted to glucose. The same holds true for the protein.

I strongly encourage you to develop protocols along these guidelines. In hospital and nursing home settings especially, there should be little difficulty in having glucose tablets and/or gel available at patients’ bedsides.

SS]