been away for a few weeks. back to work yesterday. thought i'd share a fairly average night in the ED with you regarding "the sugga" (diabetes mellitus for all you crackers out there, myself included).

10 year old type 1 comes in by EMS for seizure and low BS. fingerstick was 29 at home(that's LOW), EMS gave an amp of Dextrose (25g) and kiddo perks up. i see the patient, she looks great. watch her for a few hours, check her kidney function, feed her, and send her home with blood sugars that range from 285-150. tell mom to run a little high for now until talking to endo doc today. this same thing had happened two other times to her in the last 10 months. who knows how close she comes to death- probably not on the verge of cardiovascular or neurologic collapse, but maybe- who really knows the point of no return? the fear is there for sure. this happened once at school. the more this happens the more likely she will run high on purpose- the side effects of hyperglycemia are more of the silent killer, but at least you don't piss on yourself while you gyrate in front of your classmates.

second pt last night is a middle aged male with no medical problems but classic signs of new onset DM. blood work shows a glucose of 330, no evidence of acidosis. guy is diagnosed with DM right then and there and i start him on metformin with some fluids and a touch of insulin one time and he needs to call kaiser HMO for more definitive outpatient treatment, management and education.

this is a somewhat average day on the diabetes front in the ED. the other common entity is diabetic ketoacidosis- see a solid case about once every 7-8 shifts, with mild cases more common. hypoglycemia i see about once every 3-5 shifts and it varies from severe to mild. new onset DM i only see about once every 25 shifts probably, if that. but diabetes is all over the ED. complications are plentiful. i see dialysis pts every shift whose kidneys were knocked off by DM and noncompliance. i don't know how much compliance will be improved with inhaled insulin, but i have to believe it would be significant- especially in the type 1s. i think it will catch on later with the type 2s, but not initially- 2 maybe 3 years later it will penetrate well. just my opinion.

i'm just winding down from a shift filled with many other types of medical issues(some complete bullshit and some real emergencies), but thought i'd blog at you a little bit of what ER docs see each shift regarding the sugga.... "i got da presha, da sugga... i take a heart pill and da sugga pill and da presha pill". hey, it's better than, "Espanol?"

chad