Blood Sugar: How Low is Too Low

“The blood sugar is eighty eight. Is that okay?”

Managing blood sugar: How low is too low?

There's no one right answer to that question. The answer depends.

I got asked this today when I was helping out it my children's elementary school as a school nurse. As a volunteer, I don't have much responsibility. All the blood sugar (BS) checks are self-administered by the diabetic students. The school secretary signs the form for me as

a proof that the check is done. I'm just there as an unofficial resource an an extra pair of hands.

The school secretary is conscientious though and she checks with me if a BS of 88 is okay. In this situation: yes it is. The kid feels fine. He's just doing a routine check of his BS before lunch.

A BS level of 88 isn't always going to be fine though. I came across a situation when it was a problem just the other night.

A post operative patient with diabetes had been having difficulty getting her BS levels down - not good when you need the right levels for healing. The medical staff intervened to bring the levels back down, and were pleased when they got it down below 90. Problem fixed, right?

Wrong. The patient told me she'd been feeling weak, tired, and irritable for two days. She'd been feeling better when her sugars were running in the 200's. Of course the level needed to come down, but they've brought it down too low for her, and left her diaphoretic.

I passed on my concern to another intern and the nurse taking over. I charted it under progress notes as well. In addition, I left a stickie under the doctor's tab with my scribbles reading:

"This patient is symptomatic with blood sugars of 80-90's. She has been irritable, weak, and diaphoretic even when she's eating 6 times a day . . . Please adjust her insulin doses . . ."

I can't believe the team hadn't noticed the problem.

Sometimes a BS of 88 isn't "fine."

Have you encountered patients who get symptomatic when their blood sugar drops in the 80's or 90's? I don't really think it's that uncommon.