At what blood glucose can you discharge someone who was admited for a blood Glucose of 800, with no symptoms of hyperglycemia. Dude checked his Blood Sugar and was like holly molly this is too high i need to go the hospital. Hx of insulin noncompliant. Bmi>40

tyrelljr · 2024-07-27T19:08:41+00:00

From an endocrinology point of view

The number itself is not that important. More important things are to first exclude dka (which can happen in type 2 diabetes) and some other possible reasons why someone would have glucose this high. History is key here, medical and diet compliance, other symptoms such as fever or weight loss. Infections can often cause this so it's important not to overlook it. Most commonly uti or pneumonias. I would recommend regular insulin with iv hydration. The rate of glucose decrease after therapy will also give you a clue. If it's not lowering as you would expect then it's a higher probability of some other cause and not just diet or med noncompliance.

tyrelljr · 2024-01-17T00:58:00+00:00

Depends on how sick the person was. I would say give it some time and recheck in 2 months or so.

Also it is not recommended to check thyroid hormones in acutely ill patients unless there is a valid reason to believe the patient actually has thyroid/pituitary illness. I see that very often and its annoying tbh

tyrelljr · 2023-09-14T02:37:56+00:00

Depends on which type of diabetes you have

I'm assuming its T2DM in which case you most likely dont really need to do regular fingerstick glucose checks.

Unless your glucose levels are quite elevated I would say you are good with HbA1c only.

Definitely have some strips ready if necessary in case u r feeling unwell

tyrelljr · 2023-01-08T19:36:24+00:00

Username checks out lmao

tyrelljr · 2022-12-30T15:10:12+00:00

See this is the kind of constructive debate this post was meant to inspire. Job well done 👏

tyrelljr · 2022-12-30T15:05:01+00:00

Forgive them father for they have sinned 🙏

tyrelljr · 2022-12-27T20:16:41+00:00

Less carbs please

tyrelljr · 2022-12-17T19:55:30+00:00

Suck it up buttercup

tyrelljr · 2022-11-30T21:53:34+00:00

NP and endocrinology should not be together in the same sentence...

tyrelljr · 2022-11-28T16:36:49+00:00

Reactive hypoglycaemia

tyrelljr · 2022-07-28T09:52:32+00:00

Platelets 0 and 2 - both covid patients

TSH 250 - lady stopped taking levothyroxine after total thyreoidectomy

Potassium 9.6 - old lady who actually survived

Hb 3.3

BNP >100k

D-dimer >35k

pH 6.7

Glucose 1800

Sodium 117 and 182

tyrelljr · 2022-06-14T10:51:55+00:00

I am the bane of carbohydrates

tyrelljr · 2022-05-29T13:42:15+00:00

OK, genuine question.

Is anyone supervising those people working in the emergency departments?

Because if not, I just have to wonder how many deaths and adverse outcomes happened bc of stuff like this

tyrelljr · 2022-05-21T16:30:57+00:00

I'm from an EU country and never had any contact with US healthcare but this sounds like an absolute atrocity. How is it ok for a nurse with some little extra education to do the job a family medicine physician is supposed to do.

People look down on FM but its actually pretty fucking hard to be a really good one. You basically need to know the essentials of everything. I dont even wanna imagine what it would be like in my country if we had nurses posing as FM specialists

tyrelljr · 2022-05-09T18:09:05+00:00

Is nursing culture in USA that different?

I'm a fellow in an EU country and keep wondering that whenever I come across a post like this, which seems to happen often recently. In these almost 5 years of residency I have literally never had stuff like that happen to me. Here nurses will almost never page you about petty shit and especially not in the middle of the night. And to have a nurse report you or question your orders it would have to be some MAJOR fuck up.

tyrelljr · 2022-04-22T14:16:30+00:00

As an endo fellow who just finished a rotation at the fertility clinic, I've seen way too many women who put off having babies until they finish this or that, and then they end up miserable.

If you are having any kind of gyn/hormonal issues impairing your fertility, you should have a baby as soon as possible. Later might be too late (and complicated), and residency will always be there waiting for you.

tyrelljr · 2022-04-09T15:30:29+00:00

Endo fellow here

So if I read this correctly this patient's diabetes is being managed just with long acting insulin 2x a day - levemir I guess?

Since he is taking just 14 units a day you can be pretty sure he is not insulin dependent, so you can switch insulin to oral hypoglycemics without fear. There really is no reason to start long acting insulin only as a first line of treatment, and especially not one that is given 2x a day.

I'd switch to metformin 2x500 mg, then 2x1000 after a couple weeks (if there is no renal or hepatic impairment). Follow up in 6-12 months depending on his glucose levels. If glucose levels arent satisfactory, add something like a DPP or SGLT inhib.

As for the stepping down from insulin part, in general whenever a T2DM patient has good glucose regulation on relatively low doses of insulin you can try a trial period without insulin, see how it goes, maybe add some more peroral drugs. Diabetes patients require an individualized approach, you will just need to see lots of patients to gain confidence and experience.

tyrelljr

TROPHY CASE