Using Technology to Treat a Diabetic Emergency at Home in the Time of COVID19 Pandemic

Autor: Rachana Mundada, Cheryl Marco, Jeffrey L. Miller
Rok vydání: 2021
Předmět:
Zdroj: Journal of the Endocrine Society
ISSN: 2472-1972
DOI: 10.1210/jendso/bvab048.825
Popis: Introduction: Severe out-break of the novel coronavirus has majorly impacted the health care facilities across all settings. Hospital facilities especially the ambulatory clinics began to adjust the ways to triage, assess and treat patients by using methods that do not rely on traditional face-face encounter. Here, we present one such scenario from the initial phase of pandemic in which team effort was involved in a diabetic emergency to overcome the barriers of emergent ambulatory care. Case Description: We present a 78-year-old female with past medical history of Type 2 diabetes mellitus, hyperthyroidism, multi-nodular goiter, hypertension, mild coronary artery disease, diastolic heart failure and dyslipidemia who called the clinic with an elevated point of care glucose of 436mg/dl. Other symptoms included high fever, polyuria and polydipsia having just been discharged from hospital with a diagnosis of COVID-19 infection. She was on metformin 500 mg twice a day, glimepiride 2 mg daily, methimazole 5 mg daily, carvedilol 12.5 mg twice a day, losartan 100 mg daily, pravastatin 20 mg daily and furosemide 40 mg daily. Her most recent blood work showed an A1C of 8% (7.4 and 7.1 last year), TSH - 0.29 (0.4 -4.5 mIU/ml), FT4 - 1.1 (0.8–1.8 ng/ml), metabolic panel showed plasma glucose of 283 mg/dl along with normal electrolytes and kidney function. The patient was admitted to hospital about a week ago with flu like illness and high fever and was found to be COVID positive and was discharged home with instructions on isolation and follow up. However, while at home she noticed hyperglycemia 400–500 mg/dl despite oral agents, associated with polyuria and polydipsia but no nausea or vomiting. Given the significant symptomatic hyperglycemia along with symptomatic COVID infection it was clear that she acutely needed insulin therapy. As the patient was insulin naïve and COVID positive, there were several barriers in initiating insulin without hospitalization: we could not get her into the Endocrine office and she was declined ED evaluation because of her COVID positivity. She and the family were relatively computer novice so could not access our electronic health record video system. After discussion over the phone, our certified diabetes educator walked them through the process of downloading an app for video communication. Utilizing remote video communication, the patient’s 20-year-old grandson was educated on all the steps of Insulin use for the patient as she was still delirious. Gratifyingly, she responded well to initiation of insulin and subsequent glucoses were in the 100’s along with improvement in her symptoms. Conclusion: This case emphasizes how team effort and the zeal of health care community to serve patients can overcome shortcomings.
Databáze: OpenAIRE
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