GetMeOuttaThisMess Posted September 2, 2014 Share Posted September 2, 2014 OK, so maybe not a PA virgin, but I haven't had to deal with IDDM pts., other than when they were in the ED crashing and burning and you'd give fluids and then start them on an insulin infusion (key component listed first, and don't forget the K+!). Has anyone seen a person go from a 5.6% HbA1c to a 12.6% in 5 months without discernible extenuating circumstances? I couldn't believe it today when I got the report (along with the BS of 797 mg/dL which I received just before requesting a re-do of the HbA1c). Two of three "P's" and weight loss ("about 10 lbs" when in actuality it was 20+ over the same time period). I brought it to the attention of my SP who happened to be playing attending today and he couldn't believe it either. I'm thinking there has to be either an auto-immune issue cooking or else his pancreas got blown up by something else (no known pancreatitis that he was aware of). Oh, in case you're wondering, the CC was "dry mouth". Link to comment Share on other sites More sharing options...
Guest Paula Posted September 3, 2014 Share Posted September 3, 2014 Is this in a person without a previous diagnosis of DM? How old is the patient? I have seen some of my DM pts. with fairly normal A1c controlled with meds to A1c > 12 in a short period of time WITH extenuating circumstances which is usually related to them stopping all medications and going on an alcohol binge for months. The highest A1c I have seen is 18% in a type 1 patient (age 40) who just did not want to control her diabetes. She died young at age 42. I agree your case might be an autoimmune issue/pancreas/ or new onset diabetes Type 1 Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 3, 2014 Author Share Posted September 3, 2014 55 y/o, virgin diabetic. Co-morbid condition is HTN only. Link to comment Share on other sites More sharing options...
Moderator ventana Posted September 3, 2014 Moderator Share Posted September 3, 2014 just the other day had a guy at 6.8 about 3 months ago, and then admitted for pancreatitis last week and a1c was 10 or 12 (bad memory on my end) only had abd pain for a few days though do this could not explain the A1C elevation.... strange in deed.... ------------------------------ have had one other patient that was an "instant diabetic" at the onset of Pancreatic CA - then with stenting and radiation, he was no longer a diabetic.... but again know issue there Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 3, 2014 Author Share Posted September 3, 2014 This individual had zero pain c/o and all I could come up with was some auto-immune issue. I've had some strange creatures thus far. 2nd ED bounce in a week (first was ACS with CC of "neck pain"). House of God III, Roy Basch at the VA. Link to comment Share on other sites More sharing options...
cinntsp Posted September 3, 2014 Share Posted September 3, 2014 Is pancreatic CA on your radar? Did you order any imaging? As for A1C - the result is affected more by recent glucose levels so while we like to think of it as a picture of the last 120 days(and it is), about half of the result is from the last month. It's very possible for the result to jump quite a bit due to recent happenings. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 3, 2014 Author Share Posted September 3, 2014 He didn't hang around long enough to even appear on satellite, much less the radar. The key to great pt. care is mastering the art of the non-bounce back turf. Today it was performed skillfully if I do say so myself. It helps that the ED attending was too busy to come to the phone for report, which was fully noted in the note. When he bounces back to my clinic he will become the prized property of the first year res. Link to comment Share on other sites More sharing options...
SocialMedicine Posted September 3, 2014 Share Posted September 3, 2014 use of steroid ? cushings ? I guess this patient is going to be started immediately on an insulin regiment ? How are you going to control BS ? Patient can develop "type 1" in adult years and at random. There are some markers which can suggest more of an autoimmune process such as GAD value. I am not aware of malignancy presenting this way .. even of the pancreas. Keep us posted. Link to comment Share on other sites More sharing options...
Guest Paula Posted September 4, 2014 Share Posted September 4, 2014 He didn't hang around long enough to even appear on satellite, much less the radar. The key to great pt. care is mastering the art of the non-bounce back turf. Today it was performed skillfully if I do say so myself. It helps that the ED attending was too busy to come to the phone for report, which was fully noted in the note. When he bounces back to my clinic he will become the prized property of the first year res. Darn. You mean you don't get to work him up? It will be an interesting case so let us know the final outcome. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 4, 2014 Author Share Posted September 4, 2014 I doubt I'll see him again. At this stage I just want to move the meat. Thought/understood it to be urgent care. It's more like polypharmacy central. But hey, paychecks are coming in so I guess that counts for something. After Friday, two vacation days earned and only 256 weeks till retirement. Link to comment Share on other sites More sharing options...
kittykatufl Posted September 4, 2014 Share Posted September 4, 2014 Latent Autoimmune diabetes in adults (LADA) can progress to insulin very quickly. Not all that uncommon. Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.