Point of care testing for glucose is done by IMA nursing staff.
Depending on whether your patient is…
1) Hyperglycemic, FS >300: immediately let the attending know
- We have insulin in clinic — usually it is IMA firm D fridges. Lately, the NPH has been missing, but it is always a good idea to check in clinic first. This insulin can be given to lower a patient’s blood glucose while in clinic
- If there is no insulin in clinic, send a student to Metropolitan Pharmacy to pick up the insulin and bring back to clinic
- Draw labs (BMP, etc) and send a student to the Lab to drop them off immediately
- If the patient is asymptomatic, labs wnl, and is able to understand what to do in the case of HONK, etc — you can send the patient home with CLOSE monitoring
- MONITORING: get at least 2 numbers for the patient and check that they work
- PRESCRIPTIONS: if the patient does not have any home insulin, give an Rx for Metropolitan. If they have enough until Monday, have them wait to go to Sinai
- If the patient is symptomatic, you will have to consider whether to send them to the ER
2) Hypoglycemic and symptomatic: immediately let the attending know
- We have glucose drink (orange colored) in the TS room fridge
- Administer to the patient and monitor fingersticks
- Review meds and recommend d/c of any sulfonylureas and behavioral changes