The Paper Chase:Hyperglycemia

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No me gusta!

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Sonja R. -

very helpful review! Thank you

Clint H. -

Great review on a controversial topic. Makes me want reviews on other controversial topics or to some, not so controversial, like asymptomatic hypertension as I know there is a lot of unnecessary treatment and "chart buffing" that goes on in the community when it comes to asymptomatic hypertension.

Benjamin S., M.D. -

126 mg/dl is only stupid to those who don't realize that 125 mg/dl would be 6.944 mmol/L for the rest of the world.

Mel H. -

Ahhh - that is where it came from...turns out we are ignorant sluts! Thanks Benjamin

Preston W. -

No indication for metformen in the ed. studies clearly show that a 7% weight loss will give a similar decrease in HAIC as metformen. Counseling the patient on diet exercise and arranging followup is sufficient. The first treatment for mild new onset type 2 diabetes is not medicine.....But rather weight loss, diet , exercise.

Emilio V., MD -

Agree with prestwig, Metformin is not a benign drug, ppl have plenty of side effects, the PCP may want to start at a different dose, check an A1C do different things.
Metformin without behavior change is not going to be effective.
Educating patients and asking them to see a PCP for a type II diabetic is probably best.
As a dual trained resident (EM and FM) I got to tell you that the lines are blurred. The important thing is to develop a good outpatient system and have close follow up for your patients.
Lastly, Mel, I disagree with you, you are not ignorant :-)

Cameron -

I agree. If it is going to take weeks (at best) to get in to see a primary care doc. We need to be starting something in the ED. Metformin is best, they can uptitrate on their own with minimal downside. Some say metformin is not benign - but I say it is about as close as a drug gets and lifestyle modificications are sometimes beyond what is possible in the innnercity. A great lifestyle modification would be to stop using crack but if I can't get that what is the chance of them loosing a few pounds?

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