Can a high FBS (156) in the hospital be dismissed as hospital related stress and not Diabetes dx?
A collegue feels that a pt having just had CABG surgery is not diagnosed Diabetic based on an inpatient FBS of 156 due to the stress of surgery /hospitalization...Stating that patients always have high BSs after surgery. I have asked for a referral to the diabetic clinic for this patient in our cardiac rehab outpatient program. His doctor has not yet returned my call, but due to some weight loss in the hospital, the pt was told by his doctor that he could eat whatever he wanted for a few months..No diabetic or prediabetic teaching. What are your thoughts??
I presume you report your FBS as mg/dl which would equate to 8.7mmol/l.
Stress hyperglycaemia is recognised to occur after stress e.g. surgery/severe infection/myocardial infarction. 156mg/dl is not particularly high and could be a result of the physiological stress the patient is under. I would usually recommend a repeat fasting glucose or glucose tolerance test once the stress is over (generally once the patient has been discharged home). There are times when stress hyperglycaemia needs treating (often with insulin) whilst the individual is ill but once the stress passes this can be discontinued. As 156mg/dl is not very high it is unlikely to need treating.
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JJ-
I agree with Dr M, you should keep an eye on your bg's. If you notice a trend after you leave the hospital-Contact your Doctor for further testing. Kudo's for being pro active.
Cherise
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i agree with Dr M, even tho i'm not british :)- interestingly, the current treatment in the hospital for cardiac surgery is tight sugar control <120 to prevent infection and mortality- even for non-diabetic patients!- so high sugar acutely can cause problems, but won't do much chronically unless it is a sustained high level- hence the recheck after convalescence- cheers
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