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Simple question, but I've been out of IM for some time (I'm in Psychiatry)
You got a patient which for all intents & purposes is believed to be medically stable, but is admitted to the Psychiatric ward with a history of diabetes.
I always put such patients on sliding scale insulin. While we're told that they are medically stable, ER doctors often do not order HGB A1C's and often aren't concerned with blood sugar values less than 300. Further, psychiatric patients often have poor self care and poor cognition. They don't worry about these things. You're concerned about the psychiatric presentation usually more so than the medical concerns, but you have to be mindful of any problems that can happen medically. ER docs that clear these patients often miss important things.
Anyways, at what point is it alright to discontinue the sliding scale that is considered "standard of care". If the pt's blood sugars have been normal for some time--say 24 hours--and they seem to be diet controlled or controlled on the diabetic medications they are already on--when is it safe to discontinue?
Often times these patients can be agitated and fingersticking them isn't exactly something you want to do if it can be avoided.
You got a patient which for all intents & purposes is believed to be medically stable, but is admitted to the Psychiatric ward with a history of diabetes.
I always put such patients on sliding scale insulin. While we're told that they are medically stable, ER doctors often do not order HGB A1C's and often aren't concerned with blood sugar values less than 300. Further, psychiatric patients often have poor self care and poor cognition. They don't worry about these things. You're concerned about the psychiatric presentation usually more so than the medical concerns, but you have to be mindful of any problems that can happen medically. ER docs that clear these patients often miss important things.
Anyways, at what point is it alright to discontinue the sliding scale that is considered "standard of care". If the pt's blood sugars have been normal for some time--say 24 hours--and they seem to be diet controlled or controlled on the diabetic medications they are already on--when is it safe to discontinue?
Often times these patients can be agitated and fingersticking them isn't exactly something you want to do if it can be avoided.