[pagandeva2000]

I am an LPN that will be participating in health fairs this summer where the CNAs will be doing fingersticks and blood pressures. My responsibility will be to consult with those who have had the abnormal readings. I have a question about diabetes, fingerstick readings in particular.

The ADA states that the parameters for a diabetic should be 90mg/dl for a fasting patient, should be less than 180 mg/dl two hours after a meal. Non-diabetic parameters are about 70mg/dl and two hours after a meal, should be less than 140mg/dl. Now, my question is this; if a person's glucose reading is say; 150mg/dl, what would I tell them? Right now, the first thing I would do is ask them when was the last time they ate and if they are diabetic. If they are unsure of their status, and they told me that they ate about an hour ago or a bit more, I would tell them to follow up with their doctor-of course (and in my mind, if they ARE diabetic, then, this reading is not so bad).

I remember once, a nurse told a patient who had a reading of 135mg/dl that they were definitely diabetic. I was horrified, and told her that I would not have said this, I would have asked how long ago did this person eat (and what), and that this reading may not indicate diabetes. Also, the fact that we are there to SCREEN, not diagnose...we should refer the patient to either our hospital or to their provider for follow up and educate them on the other tests that the doctor may order to confirm a positive diagnosis such as a 2 hour post prandial, a fasting glucose and HgA1c. Also, we should review signs and symptoms to see if they have had these experiences and remind them to tell their doctors of these symptoms as well.

I just want to be sure that I am counseling them correctly, and that I have the right concept in my head. It seems that there will be more health fairs than before, and want to say the correct thing.

[kxvc]

I don't know a whole lot being a student myself. What you have looks great to me. The only thing I see is that as far as we've been taught HgA1c's are not used to diagnose DM, but are used to check comlpiance in a known diabetic. I could be wrong though.

Great Job! Have fun!

[pagandeva2000]

My job seems to use it as part of their diagnosis. They will order the 2 hour post prandial and fasting glucose, but they also ask for the HgbA1c. It makes sense to me to order it, because it would be high, anyhow, and it would tell if their diabetes is out of control by the time they are originally diagnosed. Thanks for the vote of confidence!

[earle58]

right....we never, ever diagnose.
w/borderline and abnormal readings, you ask about previously eating as well as recent illness, stress levels and/or meds that contain fructose/corn syrup.

ask them if they even have a pcp.
if not, perhaps a referral to a local med'l center...
specifically one that takes medicare and medicaid...
and to make an appt or f/u.

you'll do well pagan.
i've told you before and will tell you again:
i never worry about you.

leslie

[pagandeva2000]

Originally Posted by earle58

right....we never, ever diagnose.
w/borderline and abnormal readings, you ask about previously eating as well as recent illness, stress levels and/or meds that contain fructose/corn syrup.

ask them if they even have a pcp.
if not, perhaps a referral to a local med'l center...
specifically one that takes medicare and medicaid...
and to make an appt or f/u.

you'll do well pagan.
i've told you before and will tell you again:
i never worry about you.

leslie

Thank you, thank you, Leslie! One of the intents is to refer those who have no insurance to our city hospital. We usually go to communities we serve that have no resources to health care. Occasionally, we also provide cholesterol and PSA screenings as well.

There were quite a few occasions last summer where I had to refer patients to the emergency room who had glucose readings as high as 450mg/dl. An elderly woman who attended one of our affairs at a church last year was escorted to the ER by one of the church members. In the cases of the MANY that have refused, I documented on the sheets of paper that we return the advice to go to the ER, suggestions to follow up with either us or their own providers, advice to drink water, obtain a glucose reading and a review of signs and symptoms.

[Medic2RN]

Just a thought too.... if they have an abnormal reading, also ask them what they drank. Some people may have eaten hours ago, but will gulp down juice or soda and not think about that.

[pagandeva2000]

In addition, I usually ask if they are taking steroids. You are correct-many times, people eat danishes, breakfast/energy bars, drink sodas, etc...

[Daytonite]

I would check the various guidelines to see if this glucose screening is addressed somewhere on this website:

• National Guidelines Clearinghouse (for guidelines on procedures, etc.) http://www.guideline.gov/browse/gawithdrawn.aspx?st=A

You might also want to search on http://www2.niddk.nih.gov/ (National Institute of Diabetes and Digestive and Kidney Diseases) if you haven't already. http://www.diabetes.niddk.nih.gov/dm/a-z.asp has some nice patient things you can download and print out to hand out to patients.

[classicdame]

When I do finger sticks I use the ADA parameters. If a finger stick is >124 on two subsequent readings there is a possibility of diabetes. Remember, this is a SCREENING. So anything over 124 gets my attention and I recommend followup with an MD or NP. Better to be safe than sorry. Also, I often come across low BS too at screenings. This can be dangerous so teaching is in order. But if someone's BS is > 200 it almost does not matter when they ate. TOO HIGH.

[pagandeva2000]

Originally Posted by Daytonite

I would check the various guidelines to see if this glucose screening is addressed somewhere on this website:

• National Guidelines Clearinghouse (for guidelines on procedures, etc.) http://www.guideline.gov/browse/gawithdrawn.aspx?st=A

You might also want to search on http://www2.niddk.nih.gov/ (National Institute of Diabetes and Digestive and Kidney Diseases) if you haven't already. http://www.diabetes.niddk.nih.gov/dm/a-z.asp has some nice patient things you can download and print out to hand out to patients.

I really appreciate the web sites you provided. I'll search them through when I get home from work!