Three weeks ago, on a Thursday, we had a patient in the ER at about 8:30 pm with a glucose reading of 675 mg/dl.
The patient was a 55 y/o male who weighed about 250 pounds with type 2 diabetes which was fairly well controlled on Metformin 2000 mg/day, Glipizide 5mg bid and Januvia 100mg qd. We gave him 6 units of rapid acting insulin, his glucose returned to normal within 3 hours, and we discharged the patient with instructions to follow up with his primary care physician. The patient was back in the ER last Thursday evening with a glucose of 596/mg/dl and again we had to treat him with insulin to bring his glucose under control. I checked with the patient to see if he had had any other episodes but these were the only two.
We then retraced the patient’s actions and found that he had eaten at the same small restaurant both times; he went there every other Thursday because his wife worked in that part of town. He stated that he did not overeat at these dinners and his wife verified that he eats low carb and drinks diet sodas at all meals.
It was a mystery as to why this was happening but then one of the residents asked him for the phone to the restaurant and made a call. She came back in the room 3 minutes later and announced that she knew what was wrong.
When the resident called the restaurant she asked them to taste the diet soda and the regular soda to see if they tasted the same. Then she had them trace the lines and found that regular cola tanks were attached to both. She then verified that the tanks had not been changed in the last month and the mystery of the high glucose levels was solved.
Sometimes we try so hard to find a medical or scientific solution to a problem that we may overlook the obvious. After speaking to the patient and his wife we determined that the patient had accidently consumed 240 grams of carbs and sugar.
Gwen Arcino, R. N. Director ER
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