Checking Sugar

The thin 55-year old man looks older than me. His name sounds Chinese and he does not speak much English. Per his triage sheet, he wants his blood sugar checked.

 "Why do you want your blood sugar checked?"

"I did not bring medicine to Palau."

"When did you come to Palau?"


"Five years."


"Oh. Okay. Are you diabetic?"


"I did not bring medicine to Palau."


"Okay. Got that." (So I'll do an actual history, looking for symptoms of diabetes.)


"Have you lost any weight?"


"Nine pounds."


"Over how long a time?"


"When I came to Palau."


"So you've lost 9 pounds in five years?" (Hmmm. I've lost and gained and lost and gained again three times that much weight over five years...)


"I did not bring medicine to Palau."


"Right."


"Are you thirsty? Hungry?"


"I drink much water and always hungry."


"Over how long a time?"


"I came to Palau five years ago."


"Right. Do you urinate a lot?"


"When I drink water I urinate."


"Okay. Any moreso recently?"


"I came to Palau five years ago."


"Okay. So, again, why did you want your blood sugar checked?"


"I did not bring medicine to Palau."


"What medicine?"


"Don't know."

"Blood sugar medicine?"

"Don't know."


"Right. Do you have any other symptoms?"


"Weak."


"How long?"


"Since I came to Palau."


"Right. Along with the nine pound weight loss?"


No answer. The man looks puzzled. Not as puzzled as I feel. I see that his blood glucose was 412. That would be high if it was a fasting blood specimen.


"Did you eat anything before you came here today?"


"Big breakfast."

"Right." I do a quick exam. He's thin, but no muscle weakness and no physical signs of diabetes.


"Okay, so the blood sugar we did doesn't count because you ate first. It needs to be done again when you are fasting, I mean when you haven't eaten since the night before. You can come back here tomorrow morning and we'll do it again. Or you can do it at the hospital. But we can't give you any medicine until we know what that fasting level is. Then there might be some other tests that need done. You would have to get those at the hospital." (I've seen the Palau Hospital. It's a good place. Much like a small rural community hospital in the States.)


"Okay."

I write out an order for a fasting blood sugar. He very pleasantly shakes my hand and thanks me.


We are running a free clinic in Palau this week as part of Pacific Partnership. Guess this man got his money's worth. On the other hand, if seen by a civilian practice in our country, the exact same episode would have racked up a healthy fee for "Office Visit, Initial."

Not sure I understand the value there.