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Patients with Diabetes Are Treated Differently in the ER

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Patients with Diabetes Are Treated Differently in the ER

Jul 07, 2017

A trip to the ER is different for patients with diabetes compared to those without. Diabetes can lead to more serious complications doctors would be concerned about, as well as influence diagnostics and potential treatments. Emergency room physician Dr. Troy Madsen explains why it’s important your physicians know your diabetic status early with emergency treatment.

Episode Transcript

Interviewer: How does a patient with diabetes change the way emergency room physicians would treat you? That's next on The Scope.

Announcer: Health tips, medical views, research and more for a happier, healthier life. From the University of Utah Health Sciences, this is The Scope.

Interviewer: Dr. Madsen, if somebody comes into the emergency room and you find out they have diabetes, does that change the way that you would treat whatever condition that they're in the ER for?

Dr. Madsen: It really does. It affects the way I look at things and it often affects the way I treat things. And the reason for that is, certainly with diabetes, there are the immediate issues where maybe they have a high blood sugar or really low blood sugar. Either they use too much insulin or maybe they haven't been using their insulin, and certainly there's that factor. But diabetes changes a lot of other things as well.

So if someone comes in and they say to me, "I'm having chest pain," I mean, this is a 30-year-old otherwise healthy person, I'm like, "Okay, we'll get an EK to do some tests," I'm not too concerned. If this person has diabetes even, maybe in their 30s, that heightens my concern a little bit more for heart disease. And diabetes can cause coronary disease, causes narrowing of the coronary arteries, that's what we call the heart disease, that causes decreased blood flow, that causes heart attacks. So it's going to raise my concern for that. I'll probably do more testing, be more concerned, possibly even recommend this person stay overnight to see our cardiologists.

Another big area where it affects things is infections. If someone comes in and they have, say, an infection on their foot, maybe they stepped on a nail, and they have some sort of infection there, I might just send him home on antibiotics. But if the same person tells me they have diabetes, that's someone where I'm going to do some blood work, I'm going to be looking for a more severe infection. I might even recommend keeping them overnight on IV antibiotics because with diabetes, it may affect your ability to fight infection. So certainly, these are big things in my mind. Anytime someone tells me they have diabetes, things I'm thinking about beyond just, "Okay, what's their blood sugar?"

A third thing where this might change things a little bit for me, again, talking about this person who comes in with a certain symptom, if someone comes to the ER and says, "Okay, I hurt here in my abdomen, it's my upper abdomen," I might think, "Oh, maybe it's an ulcer." Someone in diabetes, my mind might go back to heart disease again because people with diabetes can sometimes have symptoms which are atypical or abnormal for heart attacks. That someone where I'm going to do more testing, not just on, "Okay, is your abdomen okay? Is your pancreas okay?" I'm also thinking more about the heart in that scenario as well.

Interviewer: Does that apply to Type I and Type II diabetes, these kind of rules of thumb?

Dr. Madsen: They certainly do. You know, once someone develops, also Type I diabetes would be something that typically starts when a person's younger, maybe a child or in their teenage years. Type II typically we refer to that as adult onset diabetes, they may not require insulin. But once a person has diabetes, in my mind, all these risks are things that I'm weighing the diabetes and equally with Type I and Type II for heart disease, for infections, for thinking about abdominal pain, possibly more as a heart attack. So it doesn't change a whole lot in my mind.

Interviewer: And it really, is having diabetes really kind of complicates things a little bit, doesn't it?

Dr. Madsen: It sure does. I mean, I imagine it's got to be a really tough thing to do certainly to have to deal with just the blood sugar checks and the insulin. But I think people who are on top of that, who are able to control their blood sugar well, fortunately, they're able to avoid a lot of these complications, but it's a challenging thing to do. And so that's why in the ER, I've got to think about these other potential complications and issues that the diabetes may lead to.

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