f/u about diabetes question.
I think I didn't explain my question very well. I am a cardiac rehab nurse- the BS in question is not mine. We are in the business of helping patients reduce their cardiac risk with lifestyle changes. I am told a FBS of 100 (r/t 110) -126 is a "prediabetic" and that a measure above 126 is no longer "prediabetic" but in fact gives a diagnosis of diabetes. I realize that a BS of 156 mm/dl is not a 'high' number, we see people in the 300s. However, I am trying to find clarification from someone who knows more about diabetes than I do as to rather or not a number above 126 that would normally suggest diabetes can be taken seriously if taken in the hospital. Certainly this pt will be receiving additional BS testing from their doctor at some point (next visit- 3 months away-in the meantime he's been told to 'eat whatever he wants'), but I am looking for support that would be helpful in convincing the collegues in my department to risk-stratefy this pt as diabetic or prediabetic even tho' the FBS was an inpatient post-surgery measure.
seems like there's alot of BS surrounding this case :)
well, I thought Dr M's answer was spot-on, but perhaps there's 2 different issues here. One is practical diagnostics and the other risk stratification. The actual diagnosis can't take place post op until normoglycemia is established. Some facilities screen up front by taking HbA1Cs of all patients- this is optimal, but expensive. So the practical treatment is to wait for a rescreen- even if the patient is prediabetic, there is no practical urgent treatment window (circa 3 mo.) to be filled.
that being said, I think your point about risk stratification is better preventative medicine. So, an entire screen should be done to look for secondary markers:
1- does the patient have other symptoms?- polydypsia, polyuria
2- family history of type 2?
3- recent (bellyfat) weight gain?
If a patient's preop screen captures these markers, then I think that your proactive referral is indicated. If no secondary markers, then again there is no practical diagnostic or treatment needed in this case. And of course the reductio ad absurdum is that if all post trauma hyperglycemic patients were referred for prediabetes risk, the community would become the clinic :)
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I understand the need to identify patients with diabetes at the earliest opportunity however to incorrectly diagnose diabetes is as inappropriate as to miss it. To give a patient a diagnosis of diabetes has all sorts of insurance/cost implications and may result in them recieving inappropriate medication.
Your concerns about early diagnosis are understandable but should not be at the expense of over diagnosisng diabetes.
In terms of risk stratification even those with "pre-diabetes" are at an increase risk of cardiovascular disease over the normal population (but less than the diabetic population) so even if your patient is subsequently found not to have diabetes and had pre-diabetes he/she should have their lipids/Bp etc treated aggressively.
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JJ-
I would like to thank you for taking care of your patient and being pro active in his health. I am not a Doctor of any kind. I am a person living with Diabetes. If your Dept thinks the patient has pre diabetes, he should be watching his food intake and also watching the number of carbs he is eating; at least until he goes to his appointment. I would rather see the patient get away from Pre-Diabetes; honestly diabetes at all. In order for him to be able to do so, he has to watch his diet and try to exercise as much as possible. Hope this helps.
Cherise
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