[pagandeva2000]

I have done a few health fairs for my hospital, where we do blood pressure and fingersticks for the clients. From what I have read in school, and hospital policy, normal readings are between 60-120mg/dl. If a person gets a reading such as 126mg/dl or even like a 121mg/dl, what do I tell the patient? What I have been saying thus far is that this is a screening test letting us know that this may require further follow up with a private physician. I will begin asking questions about symptoms such as the three p's, etc... leading to a basic knowledge of diabetes, acute and chronic complications and so on.

Now, I am a bit confused. It seems to me that follow up tests that would probably be done is HgbA1c, fasting glucose and basic metabolic panel. I have not seen fasting glucose ordered for any of my patients in the medical clinic. For the diabetic patient, I am told that pre-prandial glucose should be about 90-130, 2 hours post prandial should be <180.

Am I telling the patient the right thing; that the 121mg/dl (or slightly above, such as 125 or 126mg/dl) requires further investigation by their primary doctor?

Also, teaching about hyperglycemia; literature speaks of testing for ketones if their reading is above 180 (some books say 250mg/dl). How does the patient obtain the kits that check for ketones? Again, I have not seen or heard where patients we serve have done this; I don't see where the doctors are teaching or prescribing these kits for our clients. I think this is important, and would like to offer a solution, such as where to purchase this kit and when to check.

Inquiring minds want to know, and I look forward to your responses. Thanks!

[purplemania]

Your target numbers coincide with ADA standards. Continue to tell people to get the advice of an MD. They can expect a HgbA1c plus tests for hyperlipidemia and basic metabolic panel. A new dx called metabolic syndrome may be diagnosed when pts have "borderline" values on glucose, lipids etc and are overweight. Byetta is sometimes ordered for this DX to improve carb metabolism. Ketone strips are about $15/bottle at the pharmacy and do not require prescription. They are time-dated, so I only recommend them to Type I's and non-compliant or uncontrolled Type II's. Your key information in a health fair (since you don't get to see them long) is survival information. Continue to preach about it as DM is in epidemic proportions now.

[MAISY, RN-ER]

I do health screening too, are your patients fasting pre prandial when they are getting those slightly above normal numbers? Many times people are coming right after eating or recently eating and numbers are elevated. In that case, I would say 126 would be a norm-not high at all.

Maisy

[pagandeva2000]

Originally Posted by MAISY, RN-ER

I do health screening too, are your patients fasting pre prandial when they are getting those slightly above normal numbers? Many times people are coming right after eating or recently eating and numbers are elevated. In that case, I would say 126 would be a norm-not high at all.

Maisy

I doubt it if they are fasting pre-prandial at these health fairs, because in most cases, we at church functions, block parties, and other situations where food is available. And, they usually come around us after seeing what other activities are being held.

Based on the the responses I have received at this time, I think that what I was saying was safe, after all, and to always follow up with their providers. Thanks, I feel better with the counseling I have provided thus far.

[pagandeva2000]

Originally Posted by purplemania

Your target numbers coincide with ADA standards. Continue to tell people to get the advice of an MD. They can expect a HgbA1c plus tests for hyperlipidemia and basic metabolic panel. A new dx called metabolic syndrome may be diagnosed when pts have "borderline" values on glucose, lipids etc and are overweight. Byetta is sometimes ordered for this DX to improve carb metabolism. Ketone strips are about $15/bottle at the pharmacy and do not require prescription. They are time-dated, so I only recommend them to Type I's and non-compliant or uncontrolled Type II's. Your key information in a health fair (since you don't get to see them long) is survival information. Continue to preach about it as DM is in epidemic proportions now.

I appreciate this; especially about the ketone testing kits; I can share that information with the patients I counsel at my clinic on a daily basis. Another question I have for anyone who wishes to answer is how often can I tell a person to test that really cannot afford strips? This is a major problem with the population I serve; most of them are immigrants or poor that have no insurance. We provide them with free glucometers, however, they cannot afford to pay $75 for stips. I want to share information of how to utilize what they have. I know that it is best for anyone taking insulin to check after each meal and bedtime, but what about sick days, when they should test more often? My heart really goes out to them, because basically, diabetes is an expensive disease for patients, families and insurance companies. I have referred them to the Diabetic Nurse Educators, but at times, based on their work schedules, they cannot afford to take an additional sick day to visit the educators when they are barely making minimum wage or are day workers standing in the street and waiting to be picked up for jobs. I have tried to look on line to see which drug retail stores have sales, but, it is impossible to commit to keep looking up this information.

Thanks again, for your input.

[woody62]

I have been a Type 2 diabetic since 1990. And I have watched the values of what is considered a 'good' number or range change over time. What you are doing is considered just a simple screening tool designed to alert people that they may have a problem. And they should follow up with a physician or clinic. You have neither the time nor resources to teach everything that needs to be taught. An acceptable fasting blood sugar is generally between 70 to 100. And acceptable two hour post, after you eat the first bite, meal range is 120 to 160. Anyone exceeding these ranges needs a referral for follow up. An A1c is not a diagnostic tool and should never be used as one. A fasting blood sugar, followed by a five hour glucose tolerance test is an acceptable method of determining if someone is a prediabetic or a diabetic.

Those with only slightly out of acceptable range values can usually control their blood sugar by altering or lowering their carbohydrate intake daily. The average individual eats approximately 45 to 70 grams of carbohydrates at each meal. Lowering that intake can result in a drop to normal values.

Diabetes is a very silent disease. It takes it's toll on your body for years prior to ever being diagnosed. But setting unrealistic goals only dooms a patient, generally, to failure. A new diabetic needs education. If they can't get to a class because of work, direct them to a bookstore. There are numerous books on diabetes and how to control your blood sugar. There is even a "Diabetes for Dummies' book. And one that not only addresses the amount of carbohydrates you need to take but also what medications impact on it, what ones help you, what role exercise does for you.

One other thing. Although there are those that say you can stop the progression of this disease, I have found it not to be so true. I have gone from managing mine by diet and exercise alone to now having to take NPH twice a day, as well as Metformin twice a day. And eating about 70 grams of carbohydrates a day and taking long walks twice a day. I don't suffer from any of the complications, yet. And I have been a diabetic for seventeen years.

Woody