Thread by @mduanemd

Another true #DPC for the win story... Friday morning I saw a @MMMedCare patient at a school event. “I’m so glad to see you as I need to talk to you about my 5yo. For a month he has been complaining of increased thirst, so I checked his blood sugar an hour ago & it was 289!” 1/?

Child has no history of #diabetes & generally is in good health. Only other sxs -increased hunger & bed wetting. No vomiting, no confusion. Mom had checked own BS & a siblings & both were normal so it was unlikely machine error. Normally new, random BS of 289 =trip to ER
#DPC 2/?

We were at school to watch our children in a performance & her son appeared well. Still with a blood sugar of 289 after fasting all night, I knew he needed immediate follow-up so I said I should see him right after. As we left school his only complaint was “I’m hungry” #DPC 3/?

At home he eagerly ate & drank, as Mom gave history.
I checked his urine: trace glucose & ++ketones
Repeat accu-check after eating peanut butter crackers was 113 - good sign but still ketones in urine was a concern. Discussed options with mom - ER or output lab for w/u
#DPC 4/?

Since patient was mentally alert & well-hydrated AND had close follow-up, mom chose output work-up. I ordered labs stat & explained if abnormal / new onset diabetes, it may still mean trip to ER, but if it was normal we could follow closely. Went right to lab at 11:30am
#DPC 5/?

I called for results at 2pm - great news! blood glucose normal and no ketones in urine! Also HgA1C 5.7 - so no need to spend the day in ER for work up.
Later I asked the smartest #FamilyDoctor I know @kennylinafp what would his office do if patient called with new BS of 289
6/?

Also asked #pediatrician friend @CatholicDoc and both said if child had BS of 289, polydipsea & polyphagia and no history of #diabetes they would be sent directly to ER for work-up. With #DPC doctor, stat labs available for $23, we were able to save significant time & money!
7/?

Story not over though. Mom checked BS last night - was 164
Clearly child needs further work-up /close monitoring but thanks to #DirectPrimaryCare it is much easier & efficient for everyone! #DPCfortheWin! 8/8
@matteohaden @PureDPC @AtlasMD @NeuCare @innovadoc @FMEC_ @bethanyburk

#DirectPrimaryCare friends check out my thread for another #directcare success story!
@AAPSonline @IP4PI @aafp @docshanep @DoctorSammyU @PlumHealthDPC @DrBensonDO @kksheld @drmikesevilla @apjonas @purehealthmed @faithfulMDcoach @dpcalliance @DPCCoalition @rlamartini @communitasmd