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??
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.
With the Dr. I work with, if we suspect diabetes the first labs ordered are fasting bs, HBAIC, and a UA.....the HBAIC tells us if this has been going on for a longer period of time or if it is an acute onset issue, We rarely order glucose tolerance tests, although the OB/GYN's seem to use them alot.
Peeps, are you saying polyphagia is a "classic symptom"
According to the American Diabetes Association (which is quoted by emedicine.com in the link I provided) it is a symptom. If everyone with the disease does not show the same symptoms they are not "classic" or reliable are they?
The symptoms of the two are the same with the exception of elevated sugars and polyphagia. Those belong exclusively to mellitus. Without the polyphagia you have a casual bs which is not reliable enough to put someone on insulin therapy.
Repeated casual sugars? That's not what the guidelines say.
I suppose that's dependant on what the doctor wants to follow.
As in............By Big Babs
With the Dr. I work with, if we suspect diabetes the first labs ordered are fasting bs, HBAIC, and a UA.....the HBAIC tells us if this has been going on for a longer period of time or if it is an acute onset issue,
The UA would tell you volumes. If there's sugar in that sample it would rule out ADH.
HBA1C...........is that less expensive than a fasting bs? Probably less of a hassel for the patient though. A fasting sugar and a UA are comparatively diagnostic as far as I'm concerned. The +UA excludes acute onset. The HBA1C doesn't seem any more useful to me than to "police" pt compliance and efficacy.
Thank you Babs for that little glimpse into real medicine. I honestly didn't think of the UA when I looked at the guidelines. I wonder why it's not there? It's not expensive, not dependant on technique, not more technical than litmus paper is it?
I suppose that's dependant on what the doctor wants to follow.
As in............By Big Babs
The UA would tell you volumes. If there's sugar in that sample it would rule out ADH.
HBA1C...........is that less expensive than a fasting bs? Probably less of a hassel for the patient though. A fasting sugar and a UA are comparatively diagnostic as far as I'm concerned. The +UA excludes acute onset. The HBA1C doesn't seem any more useful to me than to "police" pt compliance and efficacy.
-------After thinking about this further, I forgot to mention that our lab orders usually say "Do HBAIC if bs is over 126", sorry I forgot that detail.
Thank you Babs for that little glimpse into real medicine. I honestly didn't think of the UA when I looked at the guidelines. I wonder why it's not there? It's not expensive, not dependant on technique, not more technical than litmus paper is it? [/b]
--------Its a very cheap and simple test, I think we charge like $10 or $12 for it......You just dip the little stick in the pee and them compare the colors to the guide on the bottles label, takes about 2 minutes.
--------In regards to the HBAIC, my Dr mostly uses that for dosing purposes I think, and deciding whether to go with diet, oral meds or straight to insulin.......But that's my Dr, and they ALL have their own perceptions and qwerks as far as how they do things!
Big Bab's
161 Posts
With the Dr. I work with, if we suspect diabetes the first labs ordered are fasting bs, HBAIC, and a UA.....the HBAIC tells us if this has been going on for a longer period of time or if it is an acute onset issue, We rarely order glucose tolerance tests, although the OB/GYN's seem to use them alot.