NEW DIAGNOSIS

 

TAKE HOME MESSAGE:

if a patient (not known to have diabetes) on the ward has unequivocally high glucose (e.g. > 11 mmol/L) before a meal, EVEN IN THE SETTING OF STRESS, they almost certainly have DIABETES.  Stress-induced diabetes is still DIABETES and will need follow-up after discharge.

 

    Criteria for the diagnosis of diabetes:

         -  fasting plasma glucose 7.0 mmol/L

                 OR

         -  random plasma glucose 11.1 mmol/L with symptoms of diabetes

                 OR

         -  2-hour plasma glucose in a 75-g oral glucose tolerance test 11.1 mmol/L

                 OR

         -  A1C 6.5%

 

 

   in all cases, a confirmatory test needs to be done on another day (can be either of the above 3 criteria) to officially make the diagnosis

 

Housekeeping:

   arrange nutritionist consult for education regarding diabetic diet

   most pts with diabetes are at high risk for cardiovascular disease (CVD).  Targets are an LDL-cholesterol of < 2.0 mmol/L and a BP < 130/80.  Consider starting a statin (age 40 yrs OR duration of diabetes >15 yrs AND age >30) and/or an ACE inhibitor (age 55 yrs OR macrovascular OR microvascular disease)

  referral to a Diabetes Education Program (DEP): access this link to locate a program that matches the patient's location and language needs: http://diabetes.hco-on.ca/english/Search

  arrange diabetes follow up (either with family physician or endocrinologist, keeping in mind that average waiting time for outpatient endocrinology consult is ~ 6 months)

  consider a MedicAlert bracelet especially if patient has type 1 diabetes

 

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