Management of a diabetic woman by a gynaecologist-What we should remember??

It is proposed that in future IFCC  will standardize and calliberate    All the equipment used for estimation  of HbA1c  should e equally calibrated and hopefully  IFCC will  officially release the mathematical formula subsequently the laboratories  will give  report in HbA1c    formal  expressed in %  as currently done in mmol/L  format as well as in eAG in mg%  format.

In other words HbA1c   will not be done away  with but will  be  standardized and cal liberated by IFCC method  . In addition eAG  in mg% will be calculated by mathematical  formula and given along with HbA1c  report as an additional value 7%  HbA1c  will be equivalent to 154  mg%  of glucose instead of 150mg% as at present . Hence in future indicators of long  term glycemic control and spot  or point of time  glycemic  control will be expressed in same  units. This move will be very much patient  friendly and will be welcome by all. .

Use of Glucometer in family practice

In a day to day practice of a family physician or general duty medical officer he commonly  has to deal  with routine management   including dosage      adjustments and also  handle  emergencies in a diabetic patient . thus  a properly  functioning  glucometer  with all the accessories is a must for him both   in th clinic  and in emergency bag. Glucometer  is an essential to a clinician as a stethoscope blood pressure  apparatus  and a torch.

Applications of glucometer in family  physician’s clinic

1)                       When a patient walks in with symptoms  suggestive of  diabetes. Even  though one should not  solely rely on glucometer  readings  when hyperglycemia is detected for value  will definitely  help in planning   of  further line of action including  the investigations

2)                       When a known diabetic visits the clinic for routine check  upon the eve of his departure  from the city  and thus does not have  a time for formal laboratory tests in near  future.

3)                       When  a known diabetic  attends the clinic with  symptoms which  may or may not be related to diabetes  and does  not have  a recent   laboratory  blood glucose  report.

4)                       On emergency visit. On the spot blood glucose  estimation  is a must  at  every emergency

Symptoms such as hunger palpitations sudden sweating giddiness etc could be due to hypoglycemia  Random blood glucose  on the spots  helps  to detect   or rule out hypoglycemia. In case   of hypoglycemia one should immediately correct  the low blood glucose level by serving a carbohydrate  snack  like biscuits or refined sugar  containing  liquids and subsequently   reduce dosage of his anti diabetic medications if required . In case in te patient is semi conscious or unconscious 50 ml of 25% glucose should  be injected intravenously . Hypoglycemia  in patients  on alpha  glucosidase  inhibitors should be treated by administering oral or intravenous  glucose as it does not respond to carbohydrate     snacks  or table sugar On the spot blood glucose   estimation with glucometer also helps to rule out hypoglycemia and think of alternative condition Sudden  sweating could be a symptom of acute myocardial infarction since   hypoglycemia is more common there  is a tendency in patients  to assume  that they are having hypoglycemia   and to consume two teaspoons of sugar every  10 minutes. In case of  heart attack it leads to late   diagnosis and loss of vital  time before the patient is admitted in intensive care  unit. Thus  timely on the spot blood  glucose estimation  can save  precious  time and   life as well as  lots of money  by avoiding delay  in hospitalization  in case  of serious  condition such as  acute myocardial infarction or other cardiac  emergencies or by avoiding  unnecessary hospitalization in case of simple  hypoglycemic episode  Prompt  use  of glucometer  and swift appropriate  action in only one episode  will more  than compensate for  the entire investment   cost  of glucometer.