Blood glucose

[soccrwz]

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This has been discussed before, but what to see what people are currently doing. How many people routinely getting FSG prior to procedures?

Myth #1: Epidural steroid injections do not affect blood glucose levels. Fact: Administration of epidural glucocorticoids results in temporary hyperglycemia. This usually does not result in any serious consequences. Although catastrophic complications might be imaginable, the literature is limited to a few case reports. Precautions can be taken to reduce risks.

https://cdn.ymaws.com/www.spineintervention.org/resource/resmgr/factfinder/ESI_and_Hyperglycemia_FF_4-1.pdf

 

[paindoc007]

This has been discussed before, but what to see what people are currently doing. How many people routinely getting FSG prior to procedures?

Myth #1: Epidural steroid injections do not affect blood glucose levels. Fact: Administration of epidural glucocorticoids results in temporary hyperglycemia. This usually does not result in any serious consequences. Although catastrophic complications might be imaginable, the literature is limited to a few case reports. Precautions can be taken to reduce risks.

https://cdn.ymaws.com/www.spineintervention.org/resource/resmgr/factfinder/ESI_and_Hyperglycemia_FF_4-1.pdf

I check it for anyone who is a diabetic

 

[Greenbayslacker]

Easier to ask the patient to check their own at home before coming in.

 

[Ducttape]

Easier to ask the patient to check their own at home before coming in.

"it was under 300 for a change" is not an answer I want to hear.

 

[callmeanesthesia]

"it was under 300 for a change" is not an answer I want to hear.

 

[painfree23]

Cut off for stim trials?

 

[Baron Samedi]

I use an A1C > 8 as a cutoff for stim trials/implants. I've never seen any actual published guidelines, but this study talks about complication rates for other surgeries based on A1C. As a fellow I occasionally did cases higher than that if the patient showed a downward trend and was highly reliable/motivated.

Preoperative A1C and Clinical Outcomes in Patients With Diabetes Undergoing Major Noncardiac Surgical Procedures

OBJECTIVE To evaluate the relationship between preoperative A1C and clinical outcomes in individuals with diabetes mellitus undergoing noncardiac surgery. RESEARCH DESIGN AND METHODS Data were obtained from the National Surgical Quality Improvement Program database and the Research Patient Data...

care.diabetesjournals.org

I have declined a few ESIs due to poorly controlled diabetes, but I kind of take those case by case. The last thing I want to do is put someone in a diabetic coma for temporary partial relief of chronic low back pain. I probably wouldn't do an ESI in someone >9(correlates with average BG of 212) unless they were in extremis, had strong social support, and already had a sliding scale.

 

[pmrmd]

Just avoid dex in people with sugars around 200ish. I’ve given scores of patients triamcinolone and their sugars haven’t moved. Dex would push it to 400 easy. Also dietary advice of protein-only diet for a day if using dex with higher sugars.