A nurse I work with told me she had been to the doctor 3 times in 3 weeks. She said her blood sugars had been in the 325 to 525 range.
The doc asked her "do you want to control this with pills or with diet?"
(She isn't more than 10 # over weight if that....
he meant diabetic diet. (?)
She said she has not been thirsty, has not been peeing a lot, has not been drowsy, and has not lost weight.
In your opinion, is she diabetic or not?
She has another app't next Wed. to see the doc.
I told her IMHO, she need s the pills and she is diabetic. But, I had to admit, I never heard of a diabetic who wasn't thirsty and peeing.... have you??
Specializes in ER - trauma/cardiac/burns. IV start spec.
I had a patient in the ER once that came in because "she just wasn't herself" nothing else no specific compllaints. Routine blood work chemistry came back. The PA and MD and I walked back to her room. Patient sitting on edge of stretcher laughing and talking with friends. Again more questions - mostly family hx - and any thirst, excessive voiding etc - she stated none - her glucose was 1215. I am not joking here. 1215 and no dka no nothing. She got admitted but was shocked.
So were we. I have had patients go into dka at 400. I have had patients leave with 600's. My hubby works in OR, he has had times when he had to scrub out and found his sugar to be 37 and he was still walking and able to function.
A1c is the defining criteria here. If A1c in over 6 - 6.3 you are diabetic. Diabetics also do not feel pain the same and tend to have more cornary problems without the cardinal "chest pains" symptoms.
I thought A1C was just a lab test to let the docs know how the
patients had been doing managing their glucoses for the past three months. We didn't get any inservices or info on it when it first came out.
The docs just started ordering it one day and when we ask, I heard a couple of docs say they used it to see if the patients were cheating or managing their diabetes.
No one said it was the current diagnostic tool for DM.
Couldn't I produce a 300 on a finger stick without symptoms?
I think a fasting sugar would have to be obtained. As for the HBa1C, it's my understanding that test would only be useful for management of type I and II diabetes.
As for polyuria, polydipsia, and weightloss; wouldn't those symptoms be more likely with insipidus given its etiology?
I think a fasting sugar would have to be obtained. As for the HBa1C, it's my understanding that test would only be useful for management of type I and II diabetes.
As I understand, the glycated hemoglobin tells you how well your glucose level has been controlled over the past 3 months by averaging your daily glucose levels. If I'm correct, this would give the practitioner a better idea of whether this very elevated glucose level is something that has been going on for a while or whether it is because of some acute onset.
As I understand, the glycated hemoglobin tells you how well your glucose level has been controlled over the past 3 months by averaging your daily glucose levels. If I'm correct, this would give the practitioner a better idea of whether this very elevated glucose level is something that has been going on for a while or whether it is because of some acute onset.
I disagree.
Regardless of the time of onset, a proper diagnosis must be made. A trend of blood sugar levels is used to assess the efficacy of treatment/pt compliance. It's not appropriate at the onset of symptoms.
Only a fasting level on two different occasions by a sincere pt can be useful to diagnose. The treatment of symptoms alone is a slippery, slippery slope with a team of ambulance chasers at the bottom.
Regardless of the time of onset, a proper diagnosis must be made. A trend of blood sugar levels is used to assess the efficacy of treatment/pt compliance. It's not appropriate at the onset of symptoms.
Only a fasting level on two different occasions by a sincere pt can be useful to diagnose. The treatment of symptoms alone is a slippery, slippery slope with a team of ambulance chasers at the bottom.
I'm not sure what I originally posted which can be disputed. The Hba1c is used to determine control over a 6-12 wk period and from there adjustments can be made to meds. If the glycated Hgb doesn't indicate poor control over the aforementioned time period, then it can be assumed either the diabetic pt has controlled their glucose levels over that period of time, or it is a new onset. I'm not particularly addressing dx'ing diabetes in my original post, rather stating what glycated Hgb is used for. Perhaps my use of the word acute is what mislead you, and perhaps that was a poor word choice. Substitute recent for acute maybe?
Seems I'm saying pretty much what you said about Hba1c.
Anyone interested in medical diagnosis should follow the link. It's just some site I clicked on. I don't know if they are a reliable source yet, but it sounds right. Anyone know the credibility of the source?
By Audreyfay
A casual BG of 200+ (plus symptoms) is diagnostic of diabetes.
Don't omit important factors though. The casual glucose must accompany all of the classic symptoms. In this case there is one missing. In the absence of polyphagia, the prudent thing is to get subsequent fasting sugars.
Dragonnurse1, ASN, RN
289 Posts
I had a patient in the ER once that came in because "she just wasn't herself" nothing else no specific compllaints. Routine blood work chemistry came back. The PA and MD and I walked back to her room. Patient sitting on edge of stretcher laughing and talking with friends. Again more questions - mostly family hx - and any thirst, excessive voiding etc - she stated none - her glucose was 1215. I am not joking here. 1215 and no dka no nothing. She got admitted but was shocked.
So were we. I have had patients go into dka at 400. I have had patients leave with 600's. My hubby works in OR, he has had times when he had to scrub out and found his sugar to be 37 and he was still walking and able to function.
A1c is the defining criteria here. If A1c in over 6 - 6.3 you are diabetic. Diabetics also do not feel pain the same and tend to have more cornary problems without the cardinal "chest pains" symptoms.